Healthcare Provider Details

I. General information

NPI: 1386576007
Provider Name (Legal Business Name): BRADLEY DAVID CARLSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 NICOLLET AVE
MINNEAPOLIS MN
55408-4708
US

IV. Provider business mailing address

2810 NICOLLET AVE
MINNEAPOLIS MN
55408-4708
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-7800
  • Fax:
Mailing address:
  • Phone: 612-873-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number119809
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: