=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982902482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. BRIAN LOUIS KRAGLER SR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2011
-----------------------------------------------------
Last Update Date | 03/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28511 DUPONT BLVD
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-4787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-934-8175
-----------------------------------------------------
Fax | 302-934-6842
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28511 DUPONT BLVD
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-4787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-934-8175
-----------------------------------------------------
Fax | 302-934-6842
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | A1-0001985
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 09900
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202006627
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------