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General NPI Number Information
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NPI Number | 1245125863
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Entity Type | Individual
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Provider Name | PHILLIP SHAYNE PRUNEDA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 5501 S EXPRESSWAY 77
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City | HARLINGEN
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State | TX
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Zip | 78550-3213
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Country | US
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Telephone | 956-365-1254
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 RICHIES CIR
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City | SAN JUAN
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State | TX
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Zip | 78589-0079
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Country | US
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Telephone | 956-457-2442
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 74667
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License Number State | TX
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