Provider Demographics
NPI:1245342682
Name:JUDKINS, THERESA LYNN (RPH)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:JUDKINS
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 1:117 GOLFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-2009
Mailing Address - Country:US
Mailing Address - Phone:563-285-5286
Mailing Address - Fax:563-285-5237
Practice Address - Street 1:225 E LE CLAIRE RD
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1721
Practice Address - Country:US
Practice Address - Phone:563-285-2001
Practice Address - Fax:563-285-5237
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist