Provider Demographics
NPI:1760764575
Name:BRUZZESE, TOM C (RPH)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:C
Last Name:BRUZZESE
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 1:29 NEW DERBY ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3637
Mailing Address - Country:US
Mailing Address - Phone:978-744-7442
Mailing Address - Fax:
Practice Address - Street 1:29 NEW DERBY ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3637
Practice Address - Country:US
Practice Address - Phone:978-744-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH21441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist