Healthcare Provider Details

I. General information

NPI: 1336016971
Provider Name (Legal Business Name): BRAYDEN MICHAEL LEAKE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 RIVER ST PO BOX 1157
SUPERIOR MT
59872-9673
US

IV. Provider business mailing address

207 RIVER ST PO BOX 1157
SUPERIOR MT
59872-9673
US

V. Phone/Fax

Practice location:
  • Phone: 406-822-4681
  • Fax: 406-822-0057
Mailing address:
  • Phone: 406-822-4681
  • Fax: 406-822-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-117782
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: