Provider Demographics
NPI:1386808988
Name:PRUITT, MONIQUE ELAINE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:ELAINE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W POPPYFIELDS DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-4310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 W POPPYFIELDS DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4310
Practice Address - Country:US
Practice Address - Phone:626-644-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist