Provider Demographics
NPI:1851703672
Name:HUDSON, DIANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5396
Mailing Address - Country:US
Mailing Address - Phone:336-623-6494
Mailing Address - Fax:336-623-7405
Practice Address - Street 1:304 E ARBOR LN
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5396
Practice Address - Country:US
Practice Address - Phone:336-623-6494
Practice Address - Fax:336-623-7405
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17400183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist