Provider Demographics
NPI:1033521273
Name:WEBER & JUDD CO
Entity Type:Organization
Organization Name:WEBER & JUDD CO
Other - Org Name:WEBER & JUDD - SOUTH BROADWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-289-1666
Mailing Address - Street 1:1814 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-0707
Mailing Address - Country:US
Mailing Address - Phone:507-289-1666
Mailing Address - Fax:507-536-4428
Practice Address - Street 1:18 9TH ST SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6423
Practice Address - Country:US
Practice Address - Phone:507-282-1422
Practice Address - Fax:507-282-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2644033336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145864OtherPK