Provider Demographics
NPI:1144401878
Name:HUDES, MARC ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ROBERT
Last Name:HUDES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 TROY SCHENECTADY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1007
Mailing Address - Country:US
Mailing Address - Phone:518-782-1890
Mailing Address - Fax:518-782-1495
Practice Address - Street 1:1215 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1007
Practice Address - Country:US
Practice Address - Phone:518-782-1890
Practice Address - Fax:518-782-1495
Is Sole Proprietor?:No
Enumeration Date:2007-11-22
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02655907Medicaid