Provider Demographics
NPI:1851702328
Name:HUDSON, BENJAMIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:HUDSON
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 1:807 S ISABELLA ST
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-7554
Mailing Address - Country:US
Mailing Address - Phone:229-776-3908
Mailing Address - Fax:229-776-7425
Practice Address - Street 1:807 S ISABELLA ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791
Practice Address - Country:US
Practice Address - Phone:229-776-3908
Practice Address - Fax:229-776-7425
Is Sole Proprietor?:No
Enumeration Date:2014-05-18
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist