Individual
TERESA LYNN BRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RP
Contact information
Practice address
205 W 27TH ST, SCOTTSBLUFF, NE 69361-4307
(308) 635-3296
Mailing address
1520 17TH ST, GERING, NE 69341-2702
(308) 883-1092
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12464
NE
183500000X
Pharmacist
14371-040
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12464
PHARMACIST LICENSE
NE
01
—
14371-040
PHARMACIST LICENSE
WI
Enumeration date
09/20/2006
Last updated
07/08/2007
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