Provider Demographics
NPI:1497265920
Name:HUDSON, SAMANTHA TAYLOR (MS, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:TAYLOR
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 BROOKFIELD DR NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-7797
Mailing Address - Country:US
Mailing Address - Phone:252-813-6330
Mailing Address - Fax:
Practice Address - Street 1:107 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4911
Practice Address - Country:US
Practice Address - Phone:252-537-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist