Provider Demographics
NPI:1417273582
Name:WORRALL, BRUCE MICHAEL
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:WORRALL
Suffix:
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 1:3100 N GLASSFORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2285
Mailing Address - Country:US
Mailing Address - Phone:928-445-0607
Mailing Address - Fax:928-445-0702
Practice Address - Street 1:3100 N GLASSFORD HILL RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2285
Practice Address - Country:US
Practice Address - Phone:928-445-0607
Practice Address - Fax:928-445-0702
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist