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1669754735 NPI number — BRENT ALAN MILLARD R.PH

NPI Number: 1669754735
Health Care Provider/Practitioner: BRENT ALAN MILLARD R.PH

Information about “1669754735” NPI (BRENT ALAN MILLARD R.PH) exists in 1669754735 in HTML format HTML  |  1669754735 in plain Text format TXT  |  1669754735 in PDF (Portable Document Format) PDF  |  1669754735 in an XML format XML  formats.

NPI Number : 1669754735 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669754735",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MILLARD",
    "FirstName": "BRENT",
    "MiddleName": "ALAN",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "R.PH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6746 CLEARWATER CREEK DRIVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LINO LAKES",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55038-7706",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "651-653-7532",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1207 WEST BROADWAY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FOREST LAKE",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55025",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-255-1887",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/15/2011",
    "LastUpdateDate": "09/15/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "MN115249",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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