Healthcare Provider Details

I. General information

NPI: 1275780231
Provider Name (Legal Business Name): PRUDENCE OLIVIA HOFMANN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 31403 BOX 13
APO AE
09630-1403
US

IV. Provider business mailing address

PSC 427 BOX 1093
APO AE
09630-0011
US

V. Phone/Fax

Practice location:
  • Phone: 314-636-9418
  • Fax:
Mailing address:
  • Phone: 314-636-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46349
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number46349
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number46349
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: