Provider Demographics
NPI:1649654575
Name:BRANDRIET, ERIC MARLO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MARLO
Last Name:BRANDRIET
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 1:14332 SD HIGHWAY 109
Mailing Address - Street 2:
Mailing Address - City:BIG STONE CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57216-5528
Mailing Address - Country:US
Mailing Address - Phone:605-880-2485
Mailing Address - Fax:
Practice Address - Street 1:146 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278-1409
Practice Address - Country:US
Practice Address - Phone:320-839-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist