Provider Demographics
NPI:1831503242
Name:POWELL, BRUCE EDWARD (BS)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:EDWARD
Last Name:POWELL
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2126
Mailing Address - Country:US
Mailing Address - Phone:610-649-3798
Mailing Address - Fax:610-649-0103
Practice Address - Street 1:284 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2126
Practice Address - Country:US
Practice Address - Phone:610-649-3798
Practice Address - Fax:610-649-0103
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033710L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist