Richard Brueckner II
Individual provider Active NPI Pharmacist · Wilmington, VT
NPI 1528348752 · NPPES record last updated Aug 19, 2011
Key facts
- NPI
- 1528348752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0330003750 (VT)
- Practice address
- 107 East Main St
Wilmington, VT 05363-0279 - Phone
- (802) 464-7575
- Fax
- (802) 464-7428
- NPI assigned
- Aug 19, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0330003750 | VT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0330003750 | VT | Yes |
Addresses
Primary practice location
107 East Main St
Wilmington, VT 05363-0279
Mailing address
107 East Main St
PO Box 279
Wilmington, VT 05363-0279
Phone (802) 464-7575
Other providers in Wilmington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2011. 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.