Provider Demographics
NPI:1952998791
Name:BRUNSON, DEELLA L (RPH)
Entity Type:Individual
Prefix:
First Name:DEELLA
Middle Name:L
Last Name:BRUNSON
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 1:1124 E EL CAMPO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4409
Mailing Address - Country:US
Mailing Address - Phone:702-460-1081
Mailing Address - Fax:
Practice Address - Street 1:2011 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7135
Practice Address - Country:US
Practice Address - Phone:702-649-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist