Provider Demographics
NPI:1639715634
Name:JUDGE, BARBARA JEAN
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:JUDGE
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 1:10450 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2657
Mailing Address - Country:US
Mailing Address - Phone:317-895-2247
Mailing Address - Fax:317-895-2249
Practice Address - Street 1:10450 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2657
Practice Address - Country:US
Practice Address - Phone:317-895-2247
Practice Address - Fax:317-895-2249
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist