Provider Demographics
NPI:1396144424
Name:BRUGGMAN, STEVEN ERIC (PHARM D)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ERIC
Last Name:BRUGGMAN
Suffix:
Gender:M
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 1:4124 VIA LADO
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6350
Mailing Address - Country:US
Mailing Address - Phone:310-613-9816
Mailing Address - Fax:
Practice Address - Street 1:1707 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4352
Practice Address - Country:US
Practice Address - Phone:209-526-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930378796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6475230OtherMEDICAL