Provider Demographics
NPI:1447259288
Name:FRUIT, GAYLON E (RPH)
Entity type:Individual
Prefix:MR
First Name:GAYLON
Middle Name:E
Last Name:FRUIT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3313 DARTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1448
Mailing Address - Country:US
Mailing Address - Phone:850-907-1209
Mailing Address - Fax:850-386-3643
Practice Address - Street 1:3313 DARTMOOR DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1448
Practice Address - Country:US
Practice Address - Phone:850-907-1209
Practice Address - Fax:850-386-3643
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS159461835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy