Provider Demographics
NPI:1487140018
Name:BRUZZESE, ERNEST AMERICO
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:AMERICO
Last Name:BRUZZESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MYSTIC VIEW RD
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-2428
Mailing Address - Country:US
Mailing Address - Phone:617-544-4805
Mailing Address - Fax:617-544-4826
Practice Address - Street 1:2 MYSTIC VIEW RD
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-2428
Practice Address - Country:US
Practice Address - Phone:617-544-4805
Practice Address - Fax:617-544-4826
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH14211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist