Provider Demographics
NPI:1801110473
Name:GREENWALD, BRUCE (RPH)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 W 235TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1709
Mailing Address - Country:US
Mailing Address - Phone:718-543-6868
Mailing Address - Fax:718-543-1957
Practice Address - Street 1:558 W 235TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1709
Practice Address - Country:US
Practice Address - Phone:718-543-6868
Practice Address - Fax:718-543-1957
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24344183500000X
FLPS19134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist