Provider Demographics
NPI:1205912185
Name:MCINTOSH, BRUCE ALAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:VETERANS AFFAIRS--NATIONAL CENTER FOR PATIENT SAFETY
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-0486
Mailing Address - Country:US
Mailing Address - Phone:734-930-5872
Mailing Address - Fax:734-930-5877
Practice Address - Street 1:24 FRANK LLOYD WRIGHT DR-- VA NCPS
Practice Address - Street 2:SUITE M 2100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106-0486
Practice Address - Country:US
Practice Address - Phone:734-930-5872
Practice Address - Fax:734-930-5877
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010960183500000X, 1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy