Basic Information
| Provider Information | |||||||||
| NPI: | 1730801903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRUITT | ||||||||
| FirstName: | LAURAN | ||||||||
| MiddleName: | TAYLOR | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20266 N LAKE PLEASANT RD | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853829711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235615422 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20266 N LAKE PLEASANT RD | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853829711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235615422 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2022 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | S026073 | AZ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.