Provider Demographics
NPI:1609157635
Name:JUDE, CHRISTIN NICOLE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:NICOLE
Last Name:JUDE
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 1:1710 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1054
Mailing Address - Country:US
Mailing Address - Phone:618-998-1603
Mailing Address - Fax:618-998-1608
Practice Address - Street 1:1710 W DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1054
Practice Address - Country:US
Practice Address - Phone:618-998-1603
Practice Address - Fax:618-998-1608
Is Sole Proprietor?:No
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist