Provider Demographics
NPI:1982941985
Name:STRATTON, BRUCE W (RPH)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
Last Name:STRATTON
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 1:4413 TOWN CENTER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8570
Mailing Address - Country:US
Mailing Address - Phone:904-564-3790
Mailing Address - Fax:904-564-3890
Practice Address - Street 1:4413 TOWN CENTER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8570
Practice Address - Country:US
Practice Address - Phone:904-564-3790
Practice Address - Fax:904-564-3890
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0033686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist