Healthcare Provider Details

I. General information

NPI: 1114971272
Provider Name (Legal Business Name): STEVEN J BRUIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 BEAM AVE
MAPLEWOOD MN
55109-1064
US

IV. Provider business mailing address

1431 BEAM AVE
MAPLEWOOD MN
55109-1064
US

V. Phone/Fax

Practice location:
  • Phone: 651-486-1747
  • Fax: 651-486-1744
Mailing address:
  • Phone: 651-486-1747
  • Fax: 651-486-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number118264-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: