Provider Demographics
NPI:1780148551
Name:GREENBARG, BRUCE
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:GREENBARG
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 1:10133 ISLE WYND CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-5501
Mailing Address - Country:US
Mailing Address - Phone:561-702-6671
Mailing Address - Fax:
Practice Address - Street 1:10133 ISLE WYND CT
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-5501
Practice Address - Country:US
Practice Address - Phone:561-702-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist