Provider Demographics
NPI:1467736645
Name:DICK, BRUCE TYLER (RPH)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:TYLER
Last Name:DICK
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 1:6400 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2952
Mailing Address - Country:US
Mailing Address - Phone:303-412-1327
Mailing Address - Fax:303-412-1493
Practice Address - Street 1:6400 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2952
Practice Address - Country:US
Practice Address - Phone:303-412-1327
Practice Address - Fax:303-412-1493
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist