Provider Demographics
NPI:1346024601
Name:UDE, ABIGAIL N
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:N
Last Name:UDE
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 1:3400 LONG DAY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5920
Mailing Address - Country:US
Mailing Address - Phone:512-712-8380
Mailing Address - Fax:
Practice Address - Street 1:2101 S LAMAR BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4921
Practice Address - Country:US
Practice Address - Phone:512-383-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist