Jay Bubrick, RPH
Individual provider Active NPI Pharmacist · Glendale, WI
NPI 1124458468 · NPPES record last updated Nov 23, 2013
Key facts
- NPI
- 1124458468
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 8332-040 (WI)
- Practice address
- 5320 N Port Washington Rd
Glendale, WI 53217-4913 - Phone
- (414) 963-0811
- Fax
- (414) 963-0830
- NPI assigned
- Nov 23, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8332-040 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Whitefish Bay Prescription Center LTD | Pharmacist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 8332-040 | WI | Yes |
Addresses
Primary practice location
5320 N Port Washington Rd
Glendale, WI 53217-4913
Mailing address
4961 N Wildwood Ave
Whitefish Bay, WI 53217-6015
Phone (414) 964-1693
Other providers in Glendale, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.