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General NPI Number Information
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NPI Number | 1336016971
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Entity Type | Individual
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Provider Name | BRAYDEN MICHAEL LEAKE PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 207 RIVER ST PO BOX 1157
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City | SUPERIOR
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State | MT
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Zip | 59872-9673
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Country | US
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Telephone | 406-822-4681
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Fax | 406-822-0057
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Provider Business Mailing Address
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Address Line | 207 RIVER ST PO BOX 1157
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City | SUPERIOR
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State | MT
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Zip | 59872-9673
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Country | US
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Telephone | 406-822-4681
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Fax | 406-822-0057
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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 | PHA-PHA-LIC-117782
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License Number State | MT
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