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General NPI Number Information
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NPI Number | 1528666559
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Entity Type | Individual
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Provider Name | JAMES DARWIN BRAKKE
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Gender | Male
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 250 RICHMOND WAY
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City | NEW RICHMOND
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State | WI
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Zip | 54017-6829
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Country | US
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Telephone | 715-246-9097
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Fax | 715-246-9512
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Provider Business Mailing Address
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Address Line | 473 LIBERTY CIR
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City | SOMERSET
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State | WI
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Zip | 54025-7574
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Country | US
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Telephone | 701-680-9118
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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 | 123066
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18499-40
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License Number State | WI
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