Provider Demographics
NPI:1053421560
Name:POLLY, BRUCE D (RPH)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:D
Last Name:POLLY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3733 KENESAW DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1217
Mailing Address - Country:US
Mailing Address - Phone:859-271-0133
Mailing Address - Fax:859-257-3644
Practice Address - Street 1:53 QUEENDALE CTR
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:KY
Practice Address - Zip Code:40913-9608
Practice Address - Country:US
Practice Address - Phone:606-598-3186
Practice Address - Fax:606-598-7788
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist