Provider Demographics
NPI:1952683013
Name:BREDAHL, JAMES MCKEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MCKEE
Last Name:BREDAHL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17730 189TH ST
Mailing Address - Street 2:
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086-5173
Mailing Address - Country:US
Mailing Address - Phone:785-364-8275
Mailing Address - Fax:
Practice Address - Street 1:17730 189TH ST
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-5173
Practice Address - Country:US
Practice Address - Phone:785-364-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-103491835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-10349OtherKANSAS STATE BOARD OF PHARMACY