Provider Demographics
NPI:1821375692
Name:CHUDEK, JEFF (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:CHUDEK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25925 SW HEATHER PL
Mailing Address - Street 2:T-1847
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-5785
Mailing Address - Country:US
Mailing Address - Phone:503-682-7793
Mailing Address - Fax:
Practice Address - Street 1:25925 SW HEATHER PL
Practice Address - Street 2:T-1847
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-5785
Practice Address - Country:US
Practice Address - Phone:503-682-7793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0012737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist