Provider Demographics
NPI:1609124437
Name:BRUGGER, JACQUELYN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:BRUGGER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 STATE HIGHWAY 28
Mailing Address - Street 2:T1880
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-2848
Mailing Address - Country:US
Mailing Address - Phone:920-451-8448
Mailing Address - Fax:920-917-6440
Practice Address - Street 1:4085 STATE HIGHWAY 28
Practice Address - Street 2:T1880
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-2848
Practice Address - Country:US
Practice Address - Phone:920-451-8448
Practice Address - Fax:920-917-6440
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16795-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist