Provider Demographics
NPI:1114903416
Name:PELPHREY, BRUCE LAROY (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:LAROY
Last Name:PELPHREY
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 1:7208 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2303
Mailing Address - Country:US
Mailing Address - Phone:937-813-3013
Mailing Address - Fax:
Practice Address - Street 1:7208 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2303
Practice Address - Country:US
Practice Address - Phone:937-813-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-18203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2297116Medicaid
OH2297116Medicaid