Provider Demographics
NPI:1861749822
Name:BRACKETT, ADRIANE J (PHARMD)
Entity type:Individual
Prefix:
First Name:ADRIANE
Middle Name:J
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 SUMMERELL AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8582
Mailing Address - Country:US
Mailing Address - Phone:704-473-5483
Mailing Address - Fax:
Practice Address - Street 1:311 EAST WILSON AVENUE
Practice Address - Street 2:CAMPUS BOX 3087 (SCHOOL OF PHARMACY)
Practice Address - City:WINGATE
Practice Address - State:NC
Practice Address - Zip Code:28174
Practice Address - Country:US
Practice Address - Phone:704-233-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC224841835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy