Provider Demographics
NPI:1396343034
Name:CRAKER, BRYNNA (PHARMD)
Entity type:Individual
Prefix:
First Name:BRYNNA
Middle Name:
Last Name:CRAKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BRYNNA
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3478 GERRARD AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7003
Mailing Address - Country:US
Mailing Address - Phone:218-556-2985
Mailing Address - Fax:
Practice Address - Street 1:3915 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-8166
Practice Address - Country:US
Practice Address - Phone:715-834-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124182183500000X
WI19474-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN124182OtherPHARMACIST LICENSE
WI19474-40OtherPHARMACIST LICENSE