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General NPI Number Information
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NPI Number | 1003437369
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Entity Type | Individual
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Provider Name | SAMANTHA BRENTRUP PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 323 S MINNESOTA ST
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City | CROOKSTON
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State | MN
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Zip | 56716-1601
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Country | US
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Telephone | 218-281-9420
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Fax |
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Provider Business Mailing Address
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Address Line | 426 14TH ST S
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City | MOORHEAD
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State | MN
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Zip | 56560-2958
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Country | US
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Telephone | 701-290-9717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 124146
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License Number State | MN
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