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General NPI Number Information
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NPI Number | 1588491963
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Entity Type | Individual
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Provider Name | JACOB BRIAN BRAUNSCHNEIDER
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Gender | Male
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Dates
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Enumeration Date | 09/18/2024
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 24760 HOSPITAL DRIVE
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City | RED LAKE
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State | MN
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Zip | 56671
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Country | US
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Telephone | 218-679-2825
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Fax |
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Provider Business Mailing Address
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Address Line | 710 38TH ST NW
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City | BEMIDJI
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State | MN
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Zip | 56601-2297
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Country | US
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Telephone | 586-899-4722
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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 | PS67728
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License Number State | FL
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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 | 5302416628
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License Number State | MI
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