Provider Demographics
NPI:1972839496
Name:BRUNO, ANTHONY J
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:BRUNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13107 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2931
Mailing Address - Country:US
Mailing Address - Phone:718-322-5000
Mailing Address - Fax:718-322-1280
Practice Address - Street 1:13107 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2931
Practice Address - Country:US
Practice Address - Phone:718-322-5000
Practice Address - Fax:718-322-1280
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist