Kevin Eugene Bruce, RPH
Individual provider Active NPI Pharmacist · Fenton, MO
NPI 1598047409 · NPPES record last updated Sep 16, 2011
Key facts
- NPI
- 1598047409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 041565 (MO)
- Practice address
- 1210 Sugar Creek
Fenton, MO 63026 - Phone
- (636) 326-5113
- NPI assigned
- Sep 16, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 041565 | MO | Yes |
Addresses
Primary practice location
1210 Sugar Creek
Fenton, MO 63026
Mailing address
11 Worthy CT
Fenton, MO 63026
Phone (636) 225-5797
Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.