Provider Demographics
NPI:1881035590
Name:PRUITT, AARON R (RPH)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:R
Last Name:PRUITT
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 1:3803 ENDICOTT PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5431
Mailing Address - Country:US
Mailing Address - Phone:703-409-0713
Mailing Address - Fax:
Practice Address - Street 1:3803 ENDICOTT PL
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:MD
Practice Address - Zip Code:20774-5431
Practice Address - Country:US
Practice Address - Phone:703-409-0713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist