1013022219 NPI number — BRUNO'S SUPERMARKETS, LLC.

Table of content: (NPI 1013022219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013022219 NPI number — BRUNO'S SUPERMARKETS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUNO'S SUPERMARKETS, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013022219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAULDIN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29662-0099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-213-2587
Provider Business Mailing Address Fax Number:
864-213-2503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 LILLIAN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32506-4217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-453-6525
Provider Business Practice Location Address Fax Number:
850-453-4155
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARTIN
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
864-213-2584

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  17059 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1080085 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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