Provider Demographics
NPI:1437723590
Name:KIMELBLATT, BRUCE (BS, PHARMD, MBA, RPH)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:KIMELBLATT
Suffix:
Gender:M
Credentials:BS, PHARMD, MBA, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 KETCHAM RD
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-4315
Mailing Address - Country:US
Mailing Address - Phone:609-933-1786
Mailing Address - Fax:908-904-1429
Practice Address - Street 1:117 KETCHAM RD
Practice Address - Street 2:
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502-4315
Practice Address - Country:US
Practice Address - Phone:609-933-1786
Practice Address - Fax:908-904-1429
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29550183500000X
CA29989183500000X
FL15132183500000X
NJ28RI02011700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist