Provider Demographics
NPI:1265762249
Name:DUPLISSE, BRUCE RICHARD (RPH)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:RICHARD
Last Name:DUPLISSE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5615
Mailing Address - Country:US
Mailing Address - Phone:520-293-3173
Mailing Address - Fax:520-293-7396
Practice Address - Street 1:4910 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5615
Practice Address - Country:US
Practice Address - Phone:520-293-3173
Practice Address - Fax:520-293-7396
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist