Provider Demographics
NPI:1497233936
Name:BROCKBANK, JOSHUA (PHARMD, BCPP)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:BROCKBANK
Suffix:
Gender:M
Credentials:PHARMD, BCPP
Other - Prefix:DR
Other - First Name:JOSH
Other - Middle Name:
Other - Last Name:BROCKBANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, BCPP
Mailing Address - Street 1:1 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-3018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7458368-1701183500000X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty