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General NPI Number Information
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NPI Number | 1013228162
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Entity Type | Organization
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Legal Business Name | PRUDENTIAL PHARMACY
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 777 E WHEATLAND RD #100
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City | DUNCANVILLE
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State | TX
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Zip | 75116-4918
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Country | US
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Telephone | 972-709-4500
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Fax | 972-709-4510
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Provider Business Mailing Address
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Address Line | 401 W ABRAM ST SUITE B
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City | ARLINGTON
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State | TX
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Zip | 76010-1059
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Country | US
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Telephone | 972-709-4500
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Fax | 972-709-4510
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. TONY EBUEHI
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Credential | PHARMACIST
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Telephone | 972-415-4842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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