Provider Demographics
NPI:1750671582
Name:HOUSTON, JUDITH ELAINE
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELAINE
Last Name:HOUSTON
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 1:6708 CLUCK LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-6561
Mailing Address - Country:US
Mailing Address - Phone:804-932-4336
Mailing Address - Fax:
Practice Address - Street 1:2587 NEW KENT HWY
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1735
Practice Address - Country:US
Practice Address - Phone:804-932-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist