Provider Demographics
NPI:1396850582
Name:BRUNO'S SUPERMARKETS, LLC.
Entity Type:Organization
Organization Name:BRUNO'S SUPERMARKETS, LLC.
Other - Org Name:BRUNO'S PHARMACY #125
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-213-2584
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-0099
Mailing Address - Country:US
Mailing Address - Phone:864-213-2587
Mailing Address - Fax:864-213-2503
Practice Address - Street 1:126 WILDWOOD PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-7153
Practice Address - Country:US
Practice Address - Phone:205-940-9037
Practice Address - Fax:205-941-0242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRUNO'S SUPERMARKETS, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110589332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0126082OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AL3902540014Medicare NSC