Provider Demographics
NPI:1063750685
Name:BRUCE, ANGELA CHERIE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:CHERIE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 GEORGIA HIGHWAY 20 NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3834
Mailing Address - Country:US
Mailing Address - Phone:678-413-2471
Mailing Address - Fax:678-413-2476
Practice Address - Street 1:1591 GEORGIA HIGHWAY 20 NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3834
Practice Address - Country:US
Practice Address - Phone:678-413-2471
Practice Address - Fax:678-413-2476
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018967183500000X
TX36178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist