Provider Demographics
NPI:1275828725
Name:PRUDENT, JEFFERSONIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JEFFERSONIE
Middle Name:
Last Name:PRUDENT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N MIAMI AVE
Mailing Address - Street 2:T-2188
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-3525
Mailing Address - Country:US
Mailing Address - Phone:786-437-0165
Mailing Address - Fax:786-437-0165
Practice Address - Street 1:3401 N MIAMI AVE
Practice Address - Street 2:T-2188
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3525
Practice Address - Country:US
Practice Address - Phone:786-437-0165
Practice Address - Fax:786-437-0165
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist