Healthcare Provider Details

I. General information

NPI: 1497233936
Provider Name (Legal Business Name): JOSHUA BROCKBANK PHARMD, BCPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSH BROCKBANK PHARMD, BCPP

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7458368-1701
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number7458368-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: