MEDICARE: MRS. DIANE LOUISE BRUCKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP032013L	PA

General Provider Information

NPI Number	:	1295196657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE LOUISE BRUCKER

Provider Business Mailing Address
First Line	:	1429 BURGETTSTOWN PLZ
Second Line	:
City	:	BURGETTSTOWN
State	:	PA
Zip	:	15021-1187
Country	:	US
Telephone Number	:	724-947-7000
Fax Number	:	724-947-5699

Provider Business Practice Location Address
First Line	:	1429 BURGETTSTOWN PLZ
Second Line	:
City	:	BURGETTSTOWN
State	:	PA
Zip	:	15021-1187
Country	:	US
Telephone Number	:	724-947-7000
Fax Number	:	724-947-5699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2016
Last Update Date	:	03/14/2016

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