Provider Demographics
NPI:1073819587
Name:CRUZ PRADO, JOSE LUIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:CRUZ PRADO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4391 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5795
Mailing Address - Country:US
Mailing Address - Phone:704-535-5280
Mailing Address - Fax:704-566-8476
Practice Address - Street 1:4391 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5795
Practice Address - Country:US
Practice Address - Phone:704-535-5280
Practice Address - Fax:704-566-8476
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist