Provider Demographics
NPI:1487821229
Name:BRUGH, JEAN L (RPH)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:L
Last Name:BRUGH
Suffix:
Gender:F
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:HC 34 BOX 109A
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24127-9312
Mailing Address - Country:US
Mailing Address - Phone:540-864-5833
Mailing Address - Fax:
Practice Address - Street 1:HC 34 BOX 109A
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:VA
Practice Address - Zip Code:24127-9312
Practice Address - Country:US
Practice Address - Phone:540-864-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist