Provider Demographics
NPI:1891529889
Name:BRUNE, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BRUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6100
Mailing Address - Country:US
Mailing Address - Phone:570-459-5759
Mailing Address - Fax:
Practice Address - Street 1:70 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6100
Practice Address - Country:US
Practice Address - Phone:570-459-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist