Provider Demographics
NPI:1659977759
Name:JUDSON, PRAPAIRI JOY
Entity Type:Individual
Prefix:
First Name:PRAPAIRI
Middle Name:JOY
Last Name:JUDSON
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 1:10804 SOUTHERN TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-9766
Mailing Address - Country:US
Mailing Address - Phone:903-521-5562
Mailing Address - Fax:
Practice Address - Street 1:2120 E SE LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8318
Practice Address - Country:US
Practice Address - Phone:903-593-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist