Provider Demographics
NPI:1386248458
Name:BRUSCHI, AUTUMN A (RPH)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:A
Last Name:BRUSCHI
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 1:452 MAIN RD N
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1739
Mailing Address - Country:US
Mailing Address - Phone:207-299-5201
Mailing Address - Fax:
Practice Address - Street 1:1133 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3012
Practice Address - Country:US
Practice Address - Phone:207-945-3772
Practice Address - Fax:297-942-8820
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04240183500000X
MEPR5081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist