Healthcare Provider Details

I. General information

NPI: 1952902314
Provider Name (Legal Business Name): BRUCE ALLEN FRUECHTE PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 GATEWAY DR
EAU CLAIRE WI
54701-8134
US

IV. Provider business mailing address

1506 PINE PARK DR
EAU CLAIRE WI
54701-7448
US

V. Phone/Fax

Practice location:
  • Phone: 715-839-1094
  • Fax: 715-839-1290
Mailing address:
  • Phone: 715-839-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9386-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: