Provider Demographics
NPI:1689904948
Name:BRUNO, JOSEPH G SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:G
Last Name:BRUNO
Suffix:SR
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 1:15714 90TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2732
Mailing Address - Country:US
Mailing Address - Phone:718-738-7132
Mailing Address - Fax:
Practice Address - Street 1:15714 90TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2732
Practice Address - Country:US
Practice Address - Phone:718-738-7132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist