Healthcare Provider Details

I. General information

NPI: 1265250419
Provider Name (Legal Business Name): ASHLEY JUNE BRINKMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY JUNE KISSE PHARMD

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 W MAIN ST
BEULAH ND
58523-6969
US

IV. Provider business mailing address

PO BOX 99
BEULAH ND
58523-0099
US

V. Phone/Fax

Practice location:
  • Phone: 701-873-5215
  • Fax: 701-873-4908
Mailing address:
  • Phone: 701-873-5215
  • Fax: 701-873-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH6471
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: