Provider Demographics
NPI:1306446877
Name:ANDRADE, BRUNO ELIAS (RPH)
Entity type:Individual
Prefix:
First Name:BRUNO
Middle Name:ELIAS
Last Name:ANDRADE
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 1:306 SPRING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1970
Mailing Address - Country:US
Mailing Address - Phone:434-426-8449
Mailing Address - Fax:
Practice Address - Street 1:3900 WARDS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2942
Practice Address - Country:US
Practice Address - Phone:434-832-0208
Practice Address - Fax:434-832-0210
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist