Healthcare Provider Details

I. General information

NPI: 1609823053
Provider Name (Legal Business Name): PRUITTHEALTH PHARMACY SERVICES - DURHAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 STIRRUP CREEK DR BUILDING 3, SUITE 325
DURHAM NC
27703-9411
US

IV. Provider business mailing address

1626 JEURGENS CT
NORCROSS GA
30093-2219
US

V. Phone/Fax

Practice location:
  • Phone: 919-484-2229
  • Fax:
Mailing address:
  • Phone: 678-533-6382
  • Fax: 770-931-5278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. NEIL L PRUITT JR.
Title or Position: CHAIRMAN AND CEO
Credential:
Phone: 770-279-6200