MEDICARE: TODD B PRUCHA R.PH.

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	29841	TX

General Provider Information

NPI Number	:	1417955824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD B PRUCHA R.PH.

Provider Business Mailing Address
First Line	:	2213 EVERGLADE CT
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-1534
Country	:	US
Telephone Number	:	972-323-8543
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 EVERGLADE CT
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-1534
Country	:	US
Telephone Number	:	972-323-8543
Fax Number	:

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	07/08/2007

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Directions to “ TODD B PRUCHA R.PH.” Practice Location

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