Provider Demographics
NPI:1326593518
Name:PRAHL, BRYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:PRAHL
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 1:1119 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-3310
Mailing Address - Country:US
Mailing Address - Phone:608-254-5760
Mailing Address - Fax:
Practice Address - Street 1:300 STATE HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-7902
Practice Address - Country:US
Practice Address - Phone:608-254-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18485-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist