Healthcare Provider Details

I. General information

NPI: 1215279120
Provider Name (Legal Business Name): BRIAN JOSEPH PETRUCCI RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 EMERALD COAST PKWY W STE 27B
MIRAMAR BEACH FL
32550-7222
US

IV. Provider business mailing address

9375 EMERALD COAST PKWY W STE 6
MIRAMAR BEACH FL
32550-7275
US

V. Phone/Fax

Practice location:
  • Phone: 850-424-7438
  • Fax: 850-396-0587
Mailing address:
  • Phone: 850-424-7438
  • Fax: 850-764-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS54305
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number41796
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: