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General NPI Number Information
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NPI Number | 1255489522
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Entity Type | Individual
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Provider Name | BRUCE R. ANDERSON PPH
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 530 2ND ST
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City | HUDSON
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State | WI
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Zip | 54016-1512
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Country | US
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Telephone | 715-386-3344
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Fax | 715-386-5198
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Provider Business Mailing Address
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Address Line | 2161 HERON AVE N
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City | OAKDALE
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State | MN
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Zip | 55128-5314
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Country | US
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Telephone | 651-773-0634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11051-040
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 114361-0
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License Number State | MN
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