Provider Demographics
NPI:1518389766
Name:BRUINING, STEPHEN (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BRUINING
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 1:3320 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7753
Mailing Address - Country:US
Mailing Address - Phone:616-994-1133
Mailing Address - Fax:616-994-1165
Practice Address - Street 1:3320 W SHORE DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7753
Practice Address - Country:US
Practice Address - Phone:616-994-1133
Practice Address - Fax:616-994-1165
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist