Provider Demographics
NPI:1144602145
Name:HUDSON, JODIE (RPH)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 US HIGHWAY 117 N
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-9580
Mailing Address - Country:US
Mailing Address - Phone:919-242-2067
Mailing Address - Fax:919-242-3715
Practice Address - Street 1:4700 US HIGHWAY 117 N
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27863-9580
Practice Address - Country:US
Practice Address - Phone:919-242-2067
Practice Address - Fax:919-242-3715
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist