Provider Demographics
NPI:1750596250
Name:BRUHL, JEFFERY M
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:M
Last Name:BRUHL
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 1:312 WILDERNESS COURT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447
Mailing Address - Country:US
Mailing Address - Phone:985-893-4173
Mailing Address - Fax:
Practice Address - Street 1:312 WILDERNESS COURT
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447
Practice Address - Country:US
Practice Address - Phone:985-893-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist