Provider Demographics
NPI:1447593983
Name:BREDAHL, LORRAINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:BREDAHL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:KS
Mailing Address - Zip Code:66066
Mailing Address - Country:US
Mailing Address - Phone:785-863-3401
Mailing Address - Fax:785-863-3405
Practice Address - Street 1:509 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:KS
Practice Address - Zip Code:66066
Practice Address - Country:US
Practice Address - Phone:785-863-3401
Practice Address - Fax:785-863-3405
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist