Provider Demographics
NPI:1942671276
Name:BROSNAHAN, DONALD (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:BROSNAHAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 3RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1187
Mailing Address - Country:US
Mailing Address - Phone:507-847-3282
Mailing Address - Fax:507-847-5391
Practice Address - Street 1:825 3RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1187
Practice Address - Country:US
Practice Address - Phone:507-847-3282
Practice Address - Fax:507-847-5391
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist