Healthcare Provider Details

I. General information

NPI: 1437060035
Provider Name (Legal Business Name): MELISSA BRUCKNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9576 HIGHWAY 70
MINOCQUA WI
54548-9067
US

IV. Provider business mailing address

8664 ASPEN GROVE RD APT 504
MINOCQUA WI
54548-2025
US

V. Phone/Fax

Practice location:
  • Phone: 715-439-8086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number23121-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: