Provider Demographics
NPI:1649556762
Name:HINTZE, BRYCE HENRY (PHARMACIST (BS))
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:HENRY
Last Name:HINTZE
Suffix:
Gender:M
Credentials:PHARMACIST (BS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10180 HENNEPIN TOWN RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-3175
Mailing Address - Country:US
Mailing Address - Phone:952-941-8666
Mailing Address - Fax:952-942-8582
Practice Address - Street 1:10180 HENNEPIN TOWN RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-3175
Practice Address - Country:US
Practice Address - Phone:952-941-8666
Practice Address - Fax:952-942-8582
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist