Provider Demographics
NPI:1992912992
Name:BRICKNER, CHRISTIAN ROBERT (PHARMD, CDE)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ROBERT
Last Name:BRICKNER
Suffix:
Gender:M
Credentials:PHARMD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MERRITT AVE.
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6512
Mailing Address - Country:US
Mailing Address - Phone:516-729-0588
Mailing Address - Fax:
Practice Address - Street 1:790 PARK PL.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561
Practice Address - Country:US
Practice Address - Phone:516-536-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030716183500000X
VA0202007991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist