Provider Demographics
NPI:1043527377
Name:HUDSON, SANDRA ANN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 BALL GAP RD
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8747
Mailing Address - Country:US
Mailing Address - Phone:609-458-3761
Mailing Address - Fax:
Practice Address - Street 1:41 WESTRIDGE MARKET PL
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-9174
Practice Address - Country:US
Practice Address - Phone:828-667-0851
Practice Address - Fax:828-665-9799
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist