Provider Demographics
NPI:1760703896
Name:TRUITT, MICHAEL GARREN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GARREN
Last Name:TRUITT
Suffix:
Gender:M
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 1:23814 COUNTY ROAD 99
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-9318
Mailing Address - Country:US
Mailing Address - Phone:530-666-6305
Mailing Address - Fax:
Practice Address - Street 1:1125 ALHAMBRA BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5286
Practice Address - Country:US
Practice Address - Phone:916-452-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist