Provider Demographics
NPI:1235337189
Name:PULIDO, RUPERT P (PHARMD)
Entity Type:Individual
Prefix:
First Name:RUPERT
Middle Name:P
Last Name:PULIDO
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 1:4907 SPRING AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75210-1360
Mailing Address - Country:US
Mailing Address - Phone:214-565-8551
Mailing Address - Fax:214-565-8541
Practice Address - Street 1:4907 SPRING AVE STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210-1360
Practice Address - Country:US
Practice Address - Phone:214-565-8551
Practice Address - Fax:214-565-8541
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5608183500000X
TX56338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist