Provider Demographics
NPI:1134564081
Name:BRUNO, THOMAS RUSSELL (PHARMD CANIDIATE)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RUSSELL
Last Name:BRUNO
Suffix:
Gender:M
Credentials:PHARMD CANIDIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5323
Mailing Address - Country:US
Mailing Address - Phone:239-770-8970
Mailing Address - Fax:
Practice Address - Street 1:511 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5323
Practice Address - Country:US
Practice Address - Phone:239-770-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS10669390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program