Provider Demographics
NPI:1942401732
Name:BRUECKNER, JENNIFER W (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:W
Last Name:BRUECKNER
Suffix:
Gender:F
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 1:908 SILVER PALM WAY
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2006
Mailing Address - Country:US
Mailing Address - Phone:813-317-2040
Mailing Address - Fax:
Practice Address - Street 1:5701 E HILLSBOROUGH AVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-5423
Practice Address - Country:US
Practice Address - Phone:813-317-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31520183500000X
FLPU53421835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy