Provider Demographics
NPI:1992865158
Name:MILES S JUDAH, INC
Entity Type:Organization
Organization Name:MILES S JUDAH, INC
Other - Org Name:PETE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MILES
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:863-773-4525
Mailing Address - Street 1:457 CARLTON STREET
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-3400
Mailing Address - Country:US
Mailing Address - Phone:863-773-4525
Mailing Address - Fax:863-773-2842
Practice Address - Street 1:457 CARLTON STREET
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3400
Practice Address - Country:US
Practice Address - Phone:863-773-4525
Practice Address - Fax:863-773-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH63143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH6314OtherSTATE PHARMACY LICENSE
1023340OtherNCPDP NUMBER
AP6844434OtherDEA REGISTRATION NUMBER