Provider Demographics
NPI:1205000577
Name:BRUDAPAST, DAVID ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANTHONY
Last Name:BRUDAPAST
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 1:2351 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3111
Mailing Address - Country:US
Mailing Address - Phone:216-363-2568
Mailing Address - Fax:216-694-4630
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-363-2568
Practice Address - Fax:216-694-4630
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-10966183500000X
VA0202006763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist