Provider Demographics
NPI:1811727159
Name:PRESTIGE WORLDWIDE PHARMA LLC
Entity type:Organization
Organization Name:PRESTIGE WORLDWIDE PHARMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:ILES
Authorized Official - Last Name:KLATT
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:361-227-0412
Mailing Address - Street 1:1430 S MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3334
Mailing Address - Country:US
Mailing Address - Phone:830-224-0090
Mailing Address - Fax:830-224-0095
Practice Address - Street 1:1430 S MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3334
Practice Address - Country:US
Practice Address - Phone:830-224-0090
Practice Address - Fax:830-224-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy