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Individual

MR. KELLY LYNN BRODSHO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RPH

Contact information

Practice address
2800 BROADWAY N, FARGO, ND 58102-1420
(701) 293-0221
(701) 241-7944
Mailing address
2800 BROADWAY N, FARGO, ND 58102-1420
(701) 293-0221
(701) 241-7944

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4301
ND

Other

Enumeration date
02/21/2013
Last updated
02/21/2013
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