Provider Demographics
NPI:1043034424
Name:NADREAU, BRUCE G
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:G
Last Name:NADREAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5382 VIA APPIA WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5459
Mailing Address - Country:US
Mailing Address - Phone:407-457-8462
Mailing Address - Fax:
Practice Address - Street 1:5050 WESLEY RD STE 110
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-5908
Practice Address - Country:US
Practice Address - Phone:866-943-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist