Provider Demographics
NPI:1518454164
Name:PRUDENT PHARMACY
Entity Type:Organization
Organization Name:PRUDENT PHARMACY
Other - Org Name:PRUDENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-651-1618
Mailing Address - Street 1:5575 N STATE ROAD 7 STE B
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2923
Mailing Address - Country:US
Mailing Address - Phone:954-613-0284
Mailing Address - Fax:954-361-8303
Practice Address - Street 1:5575 N STATE ROAD 7 STE B
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-613-0284
Practice Address - Fax:954-361-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy