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Individual

BRADFORD GEORGE WALLENBERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARM.D.

Contact information

Practice address
2605 W 12TH ST, SIOUX FALLS, SD 57104-3816
(605) 357-9359
(605) 357-9496
Mailing address
2605 W 12TH ST, SIOUX FALLS, SD 57104-3816
(605) 357-9359
(605) 357-9496

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3941
SD

Other

Enumeration date
08/15/2011
Last updated
08/15/2011
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