Healthcare Provider Details

I. General information

NPI: 1275535262
Provider Name (Legal Business Name): PATRICK DAVID BRACKETT JR. PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155B WALKER BUILDING
AUBURN UNIVERSITY AL
36849-0001
US

IV. Provider business mailing address

2155B WALKER BUILDING
AUBURN AL
36849-0001
US

V. Phone/Fax

Practice location:
  • Phone: 334-844-2988
  • Fax: 334-844-4346
Mailing address:
  • Phone: 334-826-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number13195
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number19749
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: