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General NPI Number Information
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NPI Number | 1306961214
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Entity Type | Individual
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Provider Name | STACEY LEA BRUCE PHARM D
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | RALPH H JOHNSON VA MEDICAL CENTER 109 BEE STREET
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City | CHARLESTON
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State | SC
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Zip | 29401-5799
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Country | US
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Telephone | 843-789-6583
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Fax |
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Provider Business Mailing Address
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Address Line | 369 ANTEBELLUM LN
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-7871
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Country | US
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Telephone | 843-412-5705
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 9861
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License Number State | SC
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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 | 9861
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License Number State | SC
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