Provider Demographics
NPI:1427187988
Name:BABCOCK, BRUCE ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ANTHONY
Last Name:BABCOCK
Suffix:
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 1:2540 E EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-6046
Mailing Address - Country:US
Mailing Address - Phone:515-262-2108
Mailing Address - Fax:515-262-7922
Practice Address - Street 1:2540 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-6046
Practice Address - Country:US
Practice Address - Phone:515-262-2108
Practice Address - Fax:515-262-7922
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist