Individual
MR. BRADY MARK BROSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.P.
Contact information
Practice address
7045 O ST, LINCOLN, NE 68510-2426
(402) 484-8222
(402) 484-7451
Mailing address
7045 O ST, LINCOLN, NE 68510-2426
(402) 484-8222
(402) 484-7451
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8659
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025934000
—
NE
Enumeration date
12/21/2011
Last updated
12/21/2011
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