Provider Demographics
NPI:1487254801
Name:BRICKNER, JOANNE LOUISE
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:LOUISE
Last Name:BRICKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W STATE ROUTE 18
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8950
Mailing Address - Country:US
Mailing Address - Phone:419-447-9177
Mailing Address - Fax:419-447-1445
Practice Address - Street 1:2801 W STATE ROUTE 18
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8950
Practice Address - Country:US
Practice Address - Phone:419-447-9177
Practice Address - Fax:419-447-1445
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03317108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist