Provider Demographics
NPI:1982095477
Name:BRUNS, MELISSA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
Last Name:BRUNS
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 1:3792 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-2624
Mailing Address - Country:US
Mailing Address - Phone:352-628-7621
Mailing Address - Fax:352-628-0532
Practice Address - Street 1:3792 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-2624
Practice Address - Country:US
Practice Address - Phone:352-628-7621
Practice Address - Fax:352-628-0532
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist