Provider Demographics
NPI:1760780886
Name:CARLO, JUDSON DUPREE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JUDSON
Middle Name:DUPREE
Last Name:CARLO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 INGALLSTON RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2213
Mailing Address - Country:US
Mailing Address - Phone:804-310-5005
Mailing Address - Fax:
Practice Address - Street 1:7199 STONEWALL PKWY
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1158
Practice Address - Country:US
Practice Address - Phone:804-730-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist