Active NPI
Brent Alan Millard, R.PH
- Pharmacist
- Forest Lake, MN
National Provider Identifier
1669754735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- MN115249
- Practice address
- 1207 West Broadway Ave
Forest Lake, MN 55025 - Phone
- (651) 255-1887
- NPI assigned
- Sep 15, 2011
- Last updated
- Sep 15, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | MN115249 | MN | Primary |
Addresses
Primary practice location
1207 West Broadway Ave
Forest Lake, MN 55025
Mailing address
6746 Clearwater Creek Drive
Lino Lakes, MN 55038-7706
Phone (651) 653-7532
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MN115249 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316044800000",
"number": "1669754735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6746 CLEARWATER CREEK DRIVE",
"city": "LINO LAKES",
"state": "MN",
"postal_code": "550387706",
"telephone_number": "651-653-7532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1207 WEST BROADWAY AVE",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "55025",
"telephone_number": "651-255-1887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLARD",
"first_name": "BRENT",
"middle_name": "ALAN",
"name_prefix": "Mr.",
"credential": "R.PH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-15",
"last_updated": "2011-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "MN115249",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.