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Individual

DR. JARRED B PRUDENCIO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARM.D.

Contact information

Practice address
45 MOHOULI ST STE 101, HILO, HI 96720-7210
(808) 932-4215
Mailing address
200 W KAWILI ST, HILO, HI 96720-4075
(808) 937-2032

Taxonomy

Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
PH-4021
HI
1835P2201X
Ambulatory Care Pharmacist
PH-4021
HI

Other

Enumeration date
10/21/2016
Last updated
10/21/2016
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