Provider Demographics
NPI:1205128212
Name:BRICKNER, JAMIE J
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:J
Last Name:BRICKNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:J
Other - Last Name:BRICKNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:120 W MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2358
Mailing Address - Country:US
Mailing Address - Phone:509-326-4343
Mailing Address - Fax:509-329-2280
Practice Address - Street 1:120 W MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2358
Practice Address - Country:US
Practice Address - Phone:509-326-4343
Practice Address - Fax:509-329-2280
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019124183500000X
ORRPH-0008866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist