Provider Demographics
NPI:1447661814
Name:PRUETTS FOOD INC
Entity type:Organization
Organization Name:PRUETTS FOOD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-584-6056
Mailing Address - Street 1:201 S PARK DR
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-4737
Mailing Address - Country:US
Mailing Address - Phone:580-584-6056
Mailing Address - Fax:
Practice Address - Street 1:410 W.L. DOC DODSON WEST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:TX
Practice Address - Zip Code:75568
Practice Address - Country:US
Practice Address - Phone:903-897-1114
Practice Address - Fax:903-897-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy