Provider Demographics
NPI:1700089497
Name:WALDMAN, JUDY L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:L
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 W 3RD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-2598
Mailing Address - Country:US
Mailing Address - Phone:605-305-1722
Mailing Address - Fax:605-305-1723
Practice Address - Street 1:2810 W 3RD ST STE 3
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-2598
Practice Address - Country:US
Practice Address - Phone:605-305-1722
Practice Address - Fax:605-305-1723
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5507183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8500872Medicaid
SD9161382Medicaid
SD1245840001Medicare ID - Type Unspecified