Provider Demographics
NPI:1659919116
Name:JUDGE, EDYTA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:EDYTA
Middle Name:
Last Name:JUDGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:EDYTA
Other - Middle Name:
Other - Last Name:ZAREBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1402 PRAIRIE VISTA CT
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-8808
Mailing Address - Country:US
Mailing Address - Phone:773-895-4610
Mailing Address - Fax:
Practice Address - Street 1:3140 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1328
Practice Address - Country:US
Practice Address - Phone:515-282-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA236313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy