Provider Demographics
NPI:1366754962
Name:BRUYNS, STACY EMILY (RPH)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:EMILY
Last Name:BRUYNS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3867
Mailing Address - Country:US
Mailing Address - Phone:802-872-9318
Mailing Address - Fax:
Practice Address - Street 1:82 PEARL ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3642
Practice Address - Country:US
Practice Address - Phone:802-878-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT3338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist