Provider Demographics
NPI:1952728552
Name:BRAATEN, GREGORY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:BRAATEN
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:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-0348
Mailing Address - Country:US
Mailing Address - Phone:218-927-2466
Mailing Address - Fax:
Practice Address - Street 1:190 SOUTHGATE DR
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-7407
Practice Address - Country:US
Practice Address - Phone:218-927-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118769183500000X
NV15401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist