Provider Demographics
NPI:1679854251
Name:BRUCK, NICK G (PHARM-D)
Entity Type:Individual
Prefix:MR
First Name:NICK
Middle Name:G
Last Name:BRUCK
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 1:3511 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2122
Mailing Address - Country:US
Mailing Address - Phone:509-220-3398
Mailing Address - Fax:
Practice Address - Street 1:10220 N NEVADA ST STE 270
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3124
Practice Address - Country:US
Practice Address - Phone:509-465-4775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6216183500000X
IL051-292929183500000X
MT6769183500000X
WAPH00055761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist