Provider Demographics
NPI:1164716809
Name:BRICKNER, DARREN MATTHEW (PHARM D)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:MATTHEW
Last Name:BRICKNER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0656
Mailing Address - Country:US
Mailing Address - Phone:509-838-1851
Mailing Address - Fax:509-838-0745
Practice Address - Street 1:112 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0656
Practice Address - Country:US
Practice Address - Phone:509-838-1851
Practice Address - Fax:509-838-0745
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-29
Last Update Date:2011-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00070708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist