Provider Demographics
NPI:1679981690
Name:BURK, BRANDON LEROY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LEROY
Last Name:BURK
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 1:1250 GOEMANN ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031
Mailing Address - Country:US
Mailing Address - Phone:507-235-2517
Mailing Address - Fax:507-235-2519
Practice Address - Street 1:1250 GOEMANN ROAD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031
Practice Address - Country:US
Practice Address - Phone:507-235-2517
Practice Address - Fax:507-235-2519
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist