Provider Demographics
NPI:1629104484
Name:HUDSON, JAMES THOMAS JR (DPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:HUDSON
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 FOLIAGE DR
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-7210
Mailing Address - Country:US
Mailing Address - Phone:580-421-9918
Mailing Address - Fax:
Practice Address - Street 1:500 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4670
Practice Address - Country:US
Practice Address - Phone:580-332-0203
Practice Address - Fax:580-332-3228
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist