Provider Demographics
NPI:1205047230
Name:LUEDTKE, BROOKE ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ANN
Last Name:LUEDTKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2012
Mailing Address - Country:US
Mailing Address - Phone:651-385-0469
Mailing Address - Fax:
Practice Address - Street 1:701 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2848
Practice Address - Country:US
Practice Address - Phone:651-267-5260
Practice Address - Fax:651-267-5936
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist