MEDICARE: DR. ANDREW LLOYD BRUCE PHARMD

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	5302040859	MI

General Provider Information

NPI Number	:	1538784855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW LLOYD BRUCE PHARMD

Provider Business Mailing Address
First Line	:	555 BRUSH ST APT 1403
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-4332
Country	:	US
Telephone Number	:	810-265-6331
Fax Number	:

Provider Business Practice Location Address
First Line	:	8463 FLETCHER RD
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8908
Country	:	US
Telephone Number	:	810-265-6331
Fax Number	:

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

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	06/12/2020

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