Provider Demographics
NPI:1174722706
Name:PRUDENCE, SHEYLANDER M (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:SHEYLANDER
Middle Name:M
Last Name:PRUDENCE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 LONG BEACH BLVD
Mailing Address - Street 2:STE 109
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2073
Mailing Address - Country:US
Mailing Address - Phone:310-386-6403
Mailing Address - Fax:310-541-4025
Practice Address - Street 1:8330 LONG BEACH BLVD
Practice Address - Street 2:STE 109
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2073
Practice Address - Country:US
Practice Address - Phone:310-386-6403
Practice Address - Fax:310-541-4025
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 50289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 50289OtherPHARMACIST