Individual
MR. BRENT ALAN MILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH
Contact information
Practice address
1207 WEST BROADWAY AVE, FOREST LAKE, MN 55025
(651) 255-1887
Mailing address
6746 CLEARWATER CREEK DRIVE, LINO LAKES, MN 55038-7706
(651) 653-7532
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
MN115249
MN
Other
Enumeration date
09/15/2011
Last updated
09/15/2011
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