Provider Demographics
NPI:1790799252
Name:BRUNO, MATILDA S (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:MATILDA
Middle Name:S
Last Name:BRUNO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 WILLOW ST
Mailing Address - Street 2:UNIT 1-C
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4063
Mailing Address - Country:US
Mailing Address - Phone:201-410-3585
Mailing Address - Fax:
Practice Address - Street 1:323 WILLOW ST
Practice Address - Street 2:UNIT 1-C
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4063
Practice Address - Country:US
Practice Address - Phone:201-410-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI019904001835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy