Healthcare Provider Details

I. General information

NPI: 1477668663
Provider Name (Legal Business Name): BRUNO'S SUPERMARKETS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 ALABAMA HWY 14
MILLBROOK AL
36054
US

IV. Provider business mailing address

PO BOX 99
MAULDIN SC
29662-0099
US

V. Phone/Fax

Practice location:
  • Phone: 334-285-1077
  • Fax: 334-285-8659
Mailing address:
  • Phone: 864-213-2587
  • Fax: 864-213-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number112149
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CURTIS HARTIN
Title or Position: SR. DIRECTOR OF PHARMACY
Credential:
Phone: 864-213-2584