Provider Demographics
NPI:1003412875
Name:BRUNETTI, ALBERTO A (RPH)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:A
Last Name:BRUNETTI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3001
Mailing Address - Country:US
Mailing Address - Phone:973-338-4143
Mailing Address - Fax:973-893-1623
Practice Address - Street 1:1409 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3001
Practice Address - Country:US
Practice Address - Phone:973-338-4143
Practice Address - Fax:973-893-1623
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01918900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist