Provider Demographics
NPI:1821142787
Name:BRUEGGEMAN, J L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:L
Last Name:BRUEGGEMAN
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 1:9301 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9103
Mailing Address - Country:US
Mailing Address - Phone:843-553-7121
Mailing Address - Fax:843-553-5800
Practice Address - Street 1:9301 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9103
Practice Address - Country:US
Practice Address - Phone:843-553-7121
Practice Address - Fax:843-553-5800
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC003558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist