Provider Demographics
NPI:1891923603
Name:PRUZZO, JUDITH JOSEPHINE (RPH)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:JOSEPHINE
Last Name:PRUZZO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:J
Other - Last Name:PRUZZO-HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:4303 SHADOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6828
Mailing Address - Country:US
Mailing Address - Phone:972-931-8760
Mailing Address - Fax:972-931-2685
Practice Address - Street 1:4303 SHADOW GLEN DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6828
Practice Address - Country:US
Practice Address - Phone:972-931-8760
Practice Address - Fax:972-931-2685
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20328183500000X
OK7991183500000X
MO27828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist