Provider Demographics
NPI:1134720279
Name:BRACKENS, JACQUELINE (RPH)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BRACKENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 RED TAILED HAWK DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-8071
Mailing Address - Country:US
Mailing Address - Phone:512-293-3843
Mailing Address - Fax:
Practice Address - Street 1:1548 FM 685
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3576
Practice Address - Country:US
Practice Address - Phone:512-252-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist