Healthcare Provider Details

I. General information

NPI: 1487843264
Provider Name (Legal Business Name): BRENDA C KRUEGER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N SAWYER ST
OSHKOSH WI
54902-4252
US

IV. Provider business mailing address

317 N SAWYER ST
OSHKOSH WI
54902-4252
US

V. Phone/Fax

Practice location:
  • Phone: 920-236-6801
  • Fax: 920-236-6813
Mailing address:
  • Phone: 920-236-6801
  • Fax: 920-236-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14596-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: