=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497042824
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH LEWIS PRATT PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2011
-----------------------------------------------------
Last Update Date | 07/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27100 EUCALYPTUS AVE T-2309
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92555-4522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-571-8015
-----------------------------------------------------
Fax | 951-571-8015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27100 EUCALYPTUS AVE T-2309
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92555-4522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-571-8015
-----------------------------------------------------
Fax | 951-571-8015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 62965
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------