Provider Demographics
NPI:1831479658
Name:BRUBAKER, BRYAN K (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:K
Last Name:BRUBAKER
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 1:13681 DOCTORS WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4300
Mailing Address - Country:US
Mailing Address - Phone:239-343-1600
Mailing Address - Fax:239-343-1601
Practice Address - Street 1:13681 DOCTORS WAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-343-0259
Practice Address - Fax:239-343-1601
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist