Provider Demographics
NPI:1205439098
Name:BRUCATO, MICHELE B (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:B
Last Name:BRUCATO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GERALDINE CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-7507
Mailing Address - Country:US
Mailing Address - Phone:775-424-2522
Mailing Address - Fax:
Practice Address - Street 1:5065 PYRAMID WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7703
Practice Address - Country:US
Practice Address - Phone:775-425-9331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9359183500000X
NV12941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist