Provider Demographics
NPI:1033713144
Name:BRUCE, AMY CAGLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CAGLE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 DUCKCOVE WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9290
Mailing Address - Country:US
Mailing Address - Phone:678-463-0134
Mailing Address - Fax:
Practice Address - Street 1:6327 HIGHWAY 53 E
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6250
Practice Address - Country:US
Practice Address - Phone:706-216-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA021278OtherBOARD OF PHARMACY