Provider Demographics
NPI:1063580751
Name:MAACK, BRODY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRODY
Middle Name:
Last Name:MAACK
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 1:523 PIPER ST
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:ND
Mailing Address - Zip Code:58051-4511
Mailing Address - Country:US
Mailing Address - Phone:701-306-9230
Mailing Address - Fax:
Practice Address - Street 1:301 NP AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4835
Practice Address - Country:US
Practice Address - Phone:701-271-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5068183500000X
MN118538183500000X
NDRPH50681835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist