Provider Demographics
NPI:1326362302
Name:KRUEGER, BRYAN J (RPH)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:J
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 E FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5213
Mailing Address - Country:US
Mailing Address - Phone:602-312-8290
Mailing Address - Fax:
Practice Address - Street 1:8826 N 23RD AVE STE C2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4174
Practice Address - Country:US
Practice Address - Phone:800-246-1843
Practice Address - Fax:800-354-0711
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-20
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS12377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist