Provider Demographics
NPI:1699096008
Name:BRUIN, KEVIN ROBERT (RPH PHARMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ROBERT
Last Name:BRUIN
Suffix:
Gender:M
Credentials:RPH PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 JARED PL
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1153
Mailing Address - Country:US
Mailing Address - Phone:419-371-6874
Mailing Address - Fax:
Practice Address - Street 1:302 W ROBB AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-2745
Practice Address - Country:US
Practice Address - Phone:419-229-5846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist