Provider Demographics
NPI:1477696060
Name:LADD, JUDY CARYL
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:CARYL
Last Name:LADD
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 1:800 WEATHERLY DR
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8957
Mailing Address - Country:US
Mailing Address - Phone:931-647-6561
Mailing Address - Fax:931-906-1254
Practice Address - Street 1:800 WEATHERLY DR
Practice Address - Street 2:SUITE 101A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8957
Practice Address - Country:US
Practice Address - Phone:931-647-6561
Practice Address - Fax:931-906-1254
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist