Healthcare Provider Details

I. General information

NPI: 1649374372
Provider Name (Legal Business Name): BRUCE PAUL LAPORTE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BLACKHORSE HILL RD
COATESVILLE PA
19320-2040
US

IV. Provider business mailing address

203 PINEHURST RD
WILMINGTON DE
19803-3125
US

V. Phone/Fax

Practice location:
  • Phone: 610-384-7711
  • Fax: 610-383-0269
Mailing address:
  • Phone: 610-383-0282
  • Fax: 610-383-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberA10001772
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: