Provider Demographics
NPI:1912140609
Name:BRAAFLAT, JEFFREY C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:BRAAFLAT
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 1:4240 WOODHAVEN ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-3946
Mailing Address - Country:US
Mailing Address - Phone:218-291-0242
Mailing Address - Fax:218-291-1293
Practice Address - Street 1:2605 8TH ST S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4203
Practice Address - Country:US
Practice Address - Phone:218-291-0242
Practice Address - Fax:218-291-1293
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-11
Last Update Date:2009-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118859183500000X
ND5120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist