Provider Demographics
NPI:1154996379
Name:BRACKEN, BARBARA (RPH)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 TEN ROD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4125
Mailing Address - Country:US
Mailing Address - Phone:401-294-3455
Mailing Address - Fax:
Practice Address - Street 1:WALMART SUPERCENTER
Practice Address - Street 2:1031 TEN ROD ROAD
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852
Practice Address - Country:US
Practice Address - Phone:401-294-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist