Provider Demographics
NPI:1043421233
Name:BRUNO, GLENN RICHARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:RICHARD
Last Name:BRUNO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18529 SE HERITAGE OAKS LN
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1413
Mailing Address - Country:US
Mailing Address - Phone:561-743-2048
Mailing Address - Fax:
Practice Address - Street 1:8867 SE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-5310
Practice Address - Country:US
Practice Address - Phone:772-546-4637
Practice Address - Fax:772-546-5868
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS16727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist