Provider Demographics
NPI:1376606616
Name:ROLLAND, BRANDON LOWELL
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:LOWELL
Last Name:ROLLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:511 1ST AVE N
Mailing Address - City:LEONARD
Mailing Address - State:ND
Mailing Address - Zip Code:58052-0443
Mailing Address - Country:US
Mailing Address - Phone:701-645-9019
Mailing Address - Fax:
Practice Address - Street 1:1401 13TH AVE E STE B
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3468
Practice Address - Country:US
Practice Address - Phone:701-364-5800
Practice Address - Fax:701-364-5802
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist