Provider Demographics
NPI:1760819981
Name:REED, BROCK HENRY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BROCK
Middle Name:HENRY
Last Name:REED
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 RANDOLPH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-5502
Mailing Address - Country:US
Mailing Address - Phone:651-201-2864
Mailing Address - Fax:
Practice Address - Street 1:335 RANDOLPH AVE STE 230
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-5502
Practice Address - Country:US
Practice Address - Phone:651-201-2864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist