Provider Demographics
NPI:1396112140
Name:BRACKETT, JENNIFER M (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1742
Mailing Address - Country:US
Mailing Address - Phone:207-664-0952
Mailing Address - Fax:207-664-0958
Practice Address - Street 1:226 HIGH ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1742
Practice Address - Country:US
Practice Address - Phone:207-664-0952
Practice Address - Fax:207-664-0958
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR45340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist