Provider Demographics
NPI:1528348752
Name:BRUECKNER, RICHARD II
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BRUECKNER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EAST MAIN ST
Mailing Address - Street 2:PO BOX 279
Mailing Address - City:WILMINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05363-0279
Mailing Address - Country:US
Mailing Address - Phone:802-464-7575
Mailing Address - Fax:802-464-7428
Practice Address - Street 1:107 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:VT
Practice Address - Zip Code:05363-0279
Practice Address - Country:US
Practice Address - Phone:802-464-7575
Practice Address - Fax:802-464-7428
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0330003750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist