Provider Demographics
NPI:1013228162
Name:PRUDENTIAL PHARMACY
Entity Type:Organization
Organization Name:PRUDENTIAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBUEHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:972-415-4842
Mailing Address - Street 1:401 W ABRAM ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-1059
Mailing Address - Country:US
Mailing Address - Phone:972-709-4500
Mailing Address - Fax:972-709-4510
Practice Address - Street 1:777 E WHEATLAND RD
Practice Address - Street 2:#100
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4918
Practice Address - Country:US
Practice Address - Phone:972-709-4500
Practice Address - Fax:972-709-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy