Provider Demographics
NPI:1073821070
Name:BRUCE, CHARLES FREDRICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FREDRICK
Last Name:BRUCE
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 1:6935 PINES RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-2515
Mailing Address - Country:US
Mailing Address - Phone:318-688-7912
Mailing Address - Fax:318-688-1351
Practice Address - Street 1:6935 PINES RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2515
Practice Address - Country:US
Practice Address - Phone:318-688-7912
Practice Address - Fax:318-688-1351
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist