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NPI Code Detail

MEDICARE: DR. BRANDI MARIE GOSSARD PHARMD

MEDICARE: DR. BRANDI MARIE GOSSARD PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P2201XAmbulatory Care Pharmacist122921MN

General Provider Information

NPI Number : 1528511839
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRANDI MARIE GOSSARD PHARMD
Provider Business Mailing Address
First Line : 12605 SCHARBER ST
Second Line :
City : ROGERS
State : MN
Zip : 55374-9534
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3620 TEXAS AVE S
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55426-4057
Country : US
Telephone Number : 952-933-3177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2016
Last Update Date : 08/03/2016

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