Healthcare Provider Details

I. General information

NPI: 1356369532
Provider Name (Legal Business Name): BRUCE'S DRUG STORE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 B EAST MAIN STREET SUITE B
SCOTTSVILLE VA
24590-0278
US

IV. Provider business mailing address

PO BOX 278 295 B EAST MAIN STREET, SUITE B
SCOTTSVILLE VA
24590-0278
US

V. Phone/Fax

Practice location:
  • Phone: 434-286-3881
  • Fax: 434-286-4733
Mailing address:
  • Phone: 434-286-3881
  • Fax: 434-286-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0201000075
License Number StateVA

VIII. Authorized Official

Name: DR. ELIZABETH S PENCE
Title or Position: CORP PRES./OWNER
Credential: PHARMD
Phone: 434-286-3881