MEDICARE: ASHLEY BRUCK

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	PH00039046	WA

General Provider Information

NPI Number	:	1972886224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BRUCK

Provider Business Mailing Address
First Line	:	108 W TURNER AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-8558
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2830 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-2528
Country	:	US
Telephone Number	:	509-455-3736
Fax Number	:	509-455-6918

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

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/22/2011

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Directions to “ ASHLEY BRUCK ” Practice Location

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