Provider Demographics
NPI:1538641758
Name:XU, BRUCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 N 2ND ST APT 1416
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1770
Mailing Address - Country:US
Mailing Address - Phone:330-421-9681
Mailing Address - Fax:
Practice Address - Street 1:4755 S 44TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-4016
Practice Address - Country:US
Practice Address - Phone:866-465-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist