Provider Demographics
NPI:1518040302
Name:BRUDER, DAVID NORMAN (R PH REGISTERED PHAR)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NORMAN
Last Name:BRUDER
Suffix:
Gender:M
Credentials:R PH REGISTERED PHAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CHINKAPIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-9145
Mailing Address - Country:US
Mailing Address - Phone:610-944-6135
Mailing Address - Fax:610-944-1320
Practice Address - Street 1:310 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-1025
Practice Address - Country:US
Practice Address - Phone:610-837-9992
Practice Address - Fax:610-837-7411
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028385L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist