Provider Demographics
NPI:1508460973
Name:PRUITT, MARYBETH JONES (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:JONES
Last Name:PRUITT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:ELLEN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3001 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24078-2244
Mailing Address - Country:US
Mailing Address - Phone:276-647-3886
Mailing Address - Fax:276-647-1036
Practice Address - Street 1:3001 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24078-2244
Practice Address - Country:US
Practice Address - Phone:276-647-3886
Practice Address - Fax:276-647-1036
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist