Provider Demographics
NPI:1487843264
Name:KRUEGER, BRENDA C (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:C
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N SAWYER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4252
Mailing Address - Country:US
Mailing Address - Phone:920-236-6801
Mailing Address - Fax:920-236-6813
Practice Address - Street 1:317 N SAWYER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4252
Practice Address - Country:US
Practice Address - Phone:920-236-6801
Practice Address - Fax:920-236-6813
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14596-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist