Provider Demographics
NPI:1215213921
Name:BRUEN, THOMAS C JR (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:BRUEN
Suffix:JR
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 1:10140 W COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-3910
Mailing Address - Country:US
Mailing Address - Phone:303-238-0488
Mailing Address - Fax:303-202-5633
Practice Address - Street 1:10140 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3910
Practice Address - Country:US
Practice Address - Phone:303-238-0488
Practice Address - Fax:303-202-5633
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA-15174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist