Healthcare Provider Details

I. General information

NPI: 1588653471
Provider Name (Legal Business Name): STEPHEN M BRUNO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 HAMPSHIRE BAY CIR
WINTER GARDEN FL
34787-5900
US

IV. Provider business mailing address

14207 HAMPSHIRE BAY CIR
WINTER GARDEN FL
34787-5900
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-4754
  • Fax: 407-654-4754
Mailing address:
  • Phone: 407-654-4754
  • Fax: 407-654-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 31128
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 018310
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPU 4888
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: