Provider Demographics
NPI:1639782311
Name:O'BRIEN, BRENNIN KYLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRENNIN
Middle Name:KYLE
Last Name:O'BRIEN
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 1:111 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BAUDETTE
Mailing Address - State:MN
Mailing Address - Zip Code:56623-2466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:BAUDETTE
Practice Address - State:MN
Practice Address - Zip Code:56623-2466
Practice Address - Country:US
Practice Address - Phone:218-634-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist