Provider Demographics
NPI:1164425112
Name:ISETTS, BRIAN JOHN (BCPS, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:ISETTS
Suffix:
Gender:M
Credentials:BCPS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 WILD TURKEY RD
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1765
Mailing Address - Country:US
Mailing Address - Phone:651-385-8353
Mailing Address - Fax:
Practice Address - Street 1:308 HARVARD ST SE
Practice Address - Street 2:RM 7-175
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0353
Practice Address - Country:US
Practice Address - Phone:612-624-2140
Practice Address - Fax:612-625-9931
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113541-11835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy