Provider Demographics
NPI:1346911062
Name:DRAGICH, BRIAN JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOHN
Last Name:DRAGICH
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 1:108 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1410
Mailing Address - Country:US
Mailing Address - Phone:320-252-1303
Mailing Address - Fax:320-252-4001
Practice Address - Street 1:108 2ND AVE S
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1410
Practice Address - Country:US
Practice Address - Phone:320-252-1303
Practice Address - Fax:320-252-4001
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist