Provider Demographics
NPI:1124458468
Name:BUBRICK, JAY (RPH)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:BUBRICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 N WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-6015
Mailing Address - Country:US
Mailing Address - Phone:414-964-1693
Mailing Address - Fax:
Practice Address - Street 1:5320 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4913
Practice Address - Country:US
Practice Address - Phone:414-963-0811
Practice Address - Fax:414-963-0830
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8332-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist