Healthcare Provider Details

I. General information

NPI: 1659293116
Provider Name (Legal Business Name): PRUNELLA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17135 W CAPITOL DR STE 110
BROOKFIELD WI
53005-2142
US

IV. Provider business mailing address

17135 W CAPITOL DR STE 110
BROOKFIELD WI
53005-2142
US

V. Phone/Fax

Practice location:
  • Phone: 262-777-6911
  • Fax: 262-777-6910
Mailing address:
  • Phone: 262-777-6911
  • Fax: 262-777-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FATMA SAAD
Title or Position: OWNER
Credential: RPH
Phone: 262-420-9525