Provider Demographics
NPI:1235656836
Name:BRUCE, JAMES CARROLL II
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CARROLL
Last Name:BRUCE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:BELCHER
Mailing Address - State:LA
Mailing Address - Zip Code:71004-0194
Mailing Address - Country:US
Mailing Address - Phone:318-458-6433
Mailing Address - Fax:
Practice Address - Street 1:7004 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5109
Practice Address - Country:US
Practice Address - Phone:318-747-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0011857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist