Provider Demographics
NPI:1255451753
Name:BRENGMAN, MICHAEL S (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:BRENGMAN
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 1:370 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992-1544
Mailing Address - Country:US
Mailing Address - Phone:507-732-5311
Mailing Address - Fax:507-732-7261
Practice Address - Street 1:370 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ZUMBROTA
Practice Address - State:MN
Practice Address - Zip Code:55992-1544
Practice Address - Country:US
Practice Address - Phone:507-732-5311
Practice Address - Fax:507-732-7261
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist