Healthcare Provider Details

I. General information

NPI: 1861481137
Provider Name (Legal Business Name): MRS. HELEN PRUITT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR 88MDG/SGQP
WRIGHT PATTERSON AFB OH
45433-5546
US

IV. Provider business mailing address

1924 S TECUMSEH RD
SPRINGFIELD OH
45502-9116
US

V. Phone/Fax

Practice location:
  • Phone: 937-904-3648
  • Fax:
Mailing address:
  • Phone: 937-323-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9090
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: