Provider Demographics
NPI:1760819981
Name:REED, BROCK HENRY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:HENRY
Last Name:REED
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 1:7845 13TH LN
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2051
Mailing Address - Country:US
Mailing Address - Phone:608-225-7587
Mailing Address - Fax:
Practice Address - Street 1:5537 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3507
Practice Address - Country:US
Practice Address - Phone:763-533-1651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist