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General NPI Number Information
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NPI Number | 1811727159
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Entity Type | Organization
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Legal Business Name | PRESTIGE WORLDWIDE PHARMA LLC
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Dates
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Enumeration Date | 08/02/2024
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 1430 S MAIN ST STE 105
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City | BOERNE
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State | TX
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Zip | 78006-3334
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Country | US
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Telephone | 830-224-0090
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Fax | 830-224-0095
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Provider Business Mailing Address
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Address Line | 1430 S MAIN ST STE 105
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City | BOERNE
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State | TX
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Zip | 78006-3334
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Country | US
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Telephone | 830-224-0090
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Fax | 830-224-0095
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Authorized Official
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Title or Position | OFFICER
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Name | DUDLEY ILES KLATT II
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Credential | PHARM.D.
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Telephone | 361-227-0412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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