Provider Demographics
NPI:1205090404
Name:DE BRUIN, ETRESIA FRANCISCA
Entity type:Individual
Prefix:MS
First Name:ETRESIA
Middle Name:FRANCISCA
Last Name:DE BRUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 WANDERER LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8284
Mailing Address - Country:US
Mailing Address - Phone:530-892-8085
Mailing Address - Fax:
Practice Address - Street 1:6646 CLARK RD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3554
Practice Address - Country:US
Practice Address - Phone:530-872-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINT22143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist