MEDICARE: RUPERT P PULIDO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	P5608	ID
2	183500000X	Pharmacist	56338	TX

General Provider Information

NPI Number	:	1235337189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUPERT P PULIDO PHARMD

Provider Business Mailing Address
First Line	:	4907 SPRING AVE STE 101
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75210-1360
Country	:	US
Telephone Number	:	214-565-8551
Fax Number	:	214-565-8541

Provider Business Practice Location Address
First Line	:	4907 SPRING AVE STE 101
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75210-1360
Country	:	US
Telephone Number	:	214-565-8551
Fax Number	:	214-565-8541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	12/09/2020

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Directions to “ RUPERT P PULIDO PHARMD” Practice Location

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