Provider Demographics
NPI:1699143156
Name:BRUGAL, CORTNEY
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:BRUGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:
Other - Last Name:BILLINGSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3881 RIM CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-1510
Mailing Address - Country:US
Mailing Address - Phone:901-409-8689
Mailing Address - Fax:
Practice Address - Street 1:3881 RIM CREEK LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135
Practice Address - Country:US
Practice Address - Phone:901-409-8689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist