Provider Demographics
NPI:1710208806
Name:BRUCKNER, STEVEN THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:THOMAS
Last Name:BRUCKNER
Suffix:
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 1:7 OAK LEAF LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5109
Mailing Address - Country:US
Mailing Address - Phone:732-505-1595
Mailing Address - Fax:
Practice Address - Street 1:570 ROUTE 70
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4014
Practice Address - Country:US
Practice Address - Phone:732-262-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02500900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist