Provider Demographics
NPI:1942730874
Name:BRUCK, CHERYL LYNNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNNE
Last Name:BRUCK
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 1:9560 STEFFAS RD
Mailing Address - Street 2:
Mailing Address - City:MAYBEE
Mailing Address - State:MI
Mailing Address - Zip Code:48159-9626
Mailing Address - Country:US
Mailing Address - Phone:419-913-6801
Mailing Address - Fax:
Practice Address - Street 1:484 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1612
Practice Address - Country:US
Practice Address - Phone:734-240-2954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist