Provider Demographics
NPI:1538834411
Name:BRUCE, CAROLINE WOODALL
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:WOODALL
Last Name:BRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 CANALSIDE ST UNIT 2005
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-6032
Mailing Address - Country:US
Mailing Address - Phone:256-293-9920
Mailing Address - Fax:
Practice Address - Street 1:1941 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2217
Practice Address - Country:US
Practice Address - Phone:803-212-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty