Healthcare Provider Details

I. General information

NPI: 1477469872
Provider Name (Legal Business Name): KATIE BRUECKNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 UXBRIDGE RD
MENDON MA
01756-1021
US

IV. Provider business mailing address

56 UXBRIDGE RD
MENDON MA
01756-1021
US

V. Phone/Fax

Practice location:
  • Phone: 508-331-0538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPH234173
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: