Provider Demographics
NPI:1437750924
Name:PRUDHOMME, DONNA L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:PRUDHOMME
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2257
Mailing Address - Country:US
Mailing Address - Phone:281-421-3024
Mailing Address - Fax:281-421-4668
Practice Address - Street 1:4900 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2257
Practice Address - Country:US
Practice Address - Phone:281-421-3024
Practice Address - Fax:281-421-4668
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist