Provider Demographics
NPI:1508298779
Name:BRAHAN, BOBBI R (PHARMD)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:R
Last Name:BRAHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-1604
Mailing Address - Country:US
Mailing Address - Phone:715-823-2350
Mailing Address - Fax:715-823-2541
Practice Address - Street 1:291 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1604
Practice Address - Country:US
Practice Address - Phone:715-823-2350
Practice Address - Fax:715-823-2541
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17170-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist