Provider Demographics
NPI:1245125863
Name:PRUNEDA, PHILLIP SHAYNE (PHARMD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:SHAYNE
Last Name:PRUNEDA
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 1:2801 RICHIES CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-0079
Mailing Address - Country:US
Mailing Address - Phone:956-457-2442
Mailing Address - Fax:
Practice Address - Street 1:5501 S EXPRESSWAY 77
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3213
Practice Address - Country:US
Practice Address - Phone:956-365-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist