Provider Demographics
NPI:1982902482
Name:KRAGLER, BRIAN LOUIS SR
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LOUIS
Last Name:KRAGLER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28511 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-4787
Mailing Address - Country:US
Mailing Address - Phone:302-934-8175
Mailing Address - Fax:302-934-6842
Practice Address - Street 1:28511 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4787
Practice Address - Country:US
Practice Address - Phone:302-934-8175
Practice Address - Fax:302-934-6842
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0001985183500000X
MD09900183500000X
VA0202006627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist