Provider Demographics
NPI:1740377548
Name:BRUFLADT, SUSAN LYNN (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:BRUFLADT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8133 S. 92ND AVE.
Mailing Address - Street 2:
Mailing Address - City:ROTHBURY
Mailing Address - State:MI
Mailing Address - Zip Code:49452
Mailing Address - Country:US
Mailing Address - Phone:231-893-7256
Mailing Address - Fax:
Practice Address - Street 1:8744 FERRY ST.
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437
Practice Address - Country:US
Practice Address - Phone:231-893-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist