Provider Demographics
NPI:1972114528
Name:BREKER, PHILLIP JOSEPH (PHARMD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JOSEPH
Last Name:BREKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6390 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2600
Mailing Address - Country:US
Mailing Address - Phone:763-585-9946
Mailing Address - Fax:763-569-9904
Practice Address - Street 1:6390 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2600
Practice Address - Country:US
Practice Address - Phone:763-585-9946
Practice Address - Fax:763-569-9904
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist