Provider Demographics
NPI:1619370129
Name:MINTO, BRUCE LEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:LEE
Last Name:MINTO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8084 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8726
Mailing Address - Country:US
Mailing Address - Phone:614-626-3896
Mailing Address - Fax:
Practice Address - Street 1:500 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1214
Practice Address - Country:US
Practice Address - Phone:614-292-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist