Provider Demographics
NPI:1386827228
Name:BRUTUS, ALTAGRACIA
Entity Type:Individual
Prefix:MS
First Name:ALTAGRACIA
Middle Name:
Last Name:BRUTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FIELDSTONE DR.
Mailing Address - Street 2:APT #156
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530
Mailing Address - Country:US
Mailing Address - Phone:914-946-3101
Mailing Address - Fax:
Practice Address - Street 1:239 E 198TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3147
Practice Address - Country:US
Practice Address - Phone:718-933-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist