Provider Demographics
NPI:1043581663
Name:BREEN, VYKE (RPH)
Entity Type:Individual
Prefix:
First Name:VYKE
Middle Name:
Last Name:BREEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215-1838
Mailing Address - Country:US
Mailing Address - Phone:320-842-4221
Mailing Address - Fax:320-842-5231
Practice Address - Street 1:1207 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1838
Practice Address - Country:US
Practice Address - Phone:320-842-4221
Practice Address - Fax:320-842-5231
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist