Provider Demographics
NPI:1902173180
Name:PRUITT, SHAWN D SR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:D
Last Name:PRUITT
Suffix:SR
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 1:811 DICKERSON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5633
Mailing Address - Country:US
Mailing Address - Phone:615-562-6337
Mailing Address - Fax:615-369-8759
Practice Address - Street 1:811 DICKERSON PIKE STE C
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-5633
Practice Address - Country:US
Practice Address - Phone:615-562-6337
Practice Address - Fax:615-369-8759
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11293OtherTENNESSEE BOARD OF PHARMACY