MEDICARE: BRUCE LIGH

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	0202004836	VA

General Provider Information

NPI Number	:	1730170820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE LIGH

Provider Business Mailing Address
First Line	:	1608 CRANBURY DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-3007
Country	:	US
Telephone Number	:	804-741-9907
Fax Number	:	804-741-9912

Provider Business Practice Location Address
First Line	:	9782 GAYTON RD
Second Line	:	UKROP'S PHARMACY #493
City	:	RICHMOND
State	:	VA
Zip	:	23238-4907
Country	:	US
Telephone Number	:	804-741-9907
Fax Number	:	804-741-9912

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

Provider Enumeration Date	:	10/29/2005
Last Update Date	:	07/08/2007

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Directions to “ BRUCE LIGH ” Practice Location

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