Provider Demographics
NPI:1023582780
Name:PRUETT, DUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:PRUETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 LOMAS SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1412
Mailing Address - Country:US
Mailing Address - Phone:858-755-6697
Mailing Address - Fax:
Practice Address - Street 1:683 LOMAS SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1412
Practice Address - Country:US
Practice Address - Phone:858-755-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist