Provider Demographics
NPI:1962691477
Name:PRUITT, KATHERYN ALEXIS (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:KATHERYN
Middle Name:ALEXIS
Last Name:PRUITT
Suffix:
Gender:F
Credentials:PHARMD, BCPS
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1670 CLAIRMONT RD
Mailing Address - Street 2:DEPARTMENT 119 (PHARMACY)
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4004
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-728-5096
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:DEPARTMENT 119 (PHARMACY)
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-728-5096
Is Sole Proprietor?:No
Enumeration Date:2007-10-20
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0236531835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy