Provider Demographics
NPI:1265864516
Name:KUDIN, ALEKSANDRA (RPH)
Entity Type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:
Last Name:KUDIN
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 1:11 WARE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-1525
Mailing Address - Country:US
Mailing Address - Phone:781-346-3501
Mailing Address - Fax:
Practice Address - Street 1:15 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7707
Practice Address - Country:US
Practice Address - Phone:508-788-0604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist