Healthcare Provider Details

I. General information

NPI: 1477463602
Provider Name (Legal Business Name): BRANDI RENE GILBERTSON CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. BRANDI RENE TAYLOR

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 BROADWAY ST S
MENOMONIE WI
54751-1822
US

IV. Provider business mailing address

433 BROADWAY ST S
MENOMONIE WI
54751-1822
US

V. Phone/Fax

Practice location:
  • Phone: 715-235-5349
  • Fax: 715-235-5379
Mailing address:
  • Phone: 715-235-5349
  • Fax: 715-235-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number236216-41
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: