Healthcare Provider Details

I. General information

NPI: 1366353534
Provider Name (Legal Business Name): BRET CARLSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST
NORTHWOOD ND
58267-4005
US

IV. Provider business mailing address

PO BOX 399
NORTHWOOD ND
58267-0399
US

V. Phone/Fax

Practice location:
  • Phone: 701-587-5271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH6215
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: