Provider Demographics
NPI:1417955824
Name:PRUCHA, TODD B (RPH)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:B
Last Name:PRUCHA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 EVERGLADE CT
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1534
Mailing Address - Country:US
Mailing Address - Phone:972-323-8543
Mailing Address - Fax:
Practice Address - Street 1:2213 EVERGLADE CT
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1534
Practice Address - Country:US
Practice Address - Phone:972-323-8543
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist