Provider Demographics
NPI:1073969614
Name:BRUHN, GREGG (RPH)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:BRUHN
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 1:1670 LARKIN AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5945
Mailing Address - Country:US
Mailing Address - Phone:847-695-0198
Mailing Address - Fax:847-695-5019
Practice Address - Street 1:1670 LARKIN AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5945
Practice Address - Country:US
Practice Address - Phone:847-695-0198
Practice Address - Fax:847-695-5019
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051031531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist