Provider Demographics
NPI:1629441035
Name:BRUDER, CYNTHIA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE
Last Name:BRUDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:MARIE
Other - Last Name:MARLINGHAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9128 SANTA MARGARITA RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADEO
Mailing Address - State:CA
Mailing Address - Zip Code:93422
Mailing Address - Country:US
Mailing Address - Phone:805-610-9516
Mailing Address - Fax:805-547-9986
Practice Address - Street 1:717 MARSH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3901
Practice Address - Country:US
Practice Address - Phone:805-547-9885
Practice Address - Fax:805-547-9986
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist