Healthcare Provider Details

I. General information

NPI: 1174722706
Provider Name (Legal Business Name): SHEYLANDER M PRUDENCE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 W AVENUE J
LANCASTER CA
93536-5913
US

IV. Provider business mailing address

2006 W AVENUE J
LANCASTER CA
93536-5913
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-2729
  • Fax: 661-949-7022
Mailing address:
  • Phone: 661-945-2729
  • Fax: 661-949-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 50289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: