Healthcare Provider Details

I. General information

NPI: 1790780682
Provider Name (Legal Business Name): SUSAN PATRICIA BRUCE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 WASHINGTON AVE STE 101
ALBANY NY
12206-1043
US

IV. Provider business mailing address

58 BELVIDERE AVE
ALBANY NY
12203-2416
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-4471
  • Fax: 518-489-4506
Mailing address:
  • Phone: 518-482-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number046661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: