Healthcare Provider Details

I. General information

NPI: 1386694826
Provider Name (Legal Business Name): BRADLEY DEAN MORRISON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BURDICK EXPY E
MINOT ND
58701-4768
US

IV. Provider business mailing address

5500 86TH ST SW
MINOT ND
58701-8820
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-7900
  • Fax: 701-857-7834
Mailing address:
  • Phone: 701-722-3934
  • Fax: 701-839-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4519
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: