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NPI Code Detail

MEDICARE: INDYA BRUCE

MEDICARE: INDYA BRUCE
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
1183500000XPharmacist023127LA

General Provider Information

NPI Number : 1720636798
Entity Type Code : Individual
Provider Name (Legal Business Name) : INDYA BRUCE
Provider Business Mailing Address
First Line : 10201 PARK ROWE AVE APT 2319
Second Line :
City : BATON ROUGE
State : LA
Zip : 70810-2295
Country : US
Telephone Number : 504-338-0589
Fax Number :
Provider Business Practice Location Address
First Line : 14360 WAX RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70818-4279
Country : US
Telephone Number : 225-261-6541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2019
Last Update Date : 09/03/2019

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Directions to “ INDYA BRUCE ” Practice Location

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