Provider Demographics
NPI:1801457379
Name:HUDOBA, DAVID JOHN (PHARMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:HUDOBA
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 1:140 FAIRGROUND BLVD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1617
Mailing Address - Country:US
Mailing Address - Phone:330-518-1947
Mailing Address - Fax:
Practice Address - Street 1:7880 LINCOLE PL
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8322
Practice Address - Country:US
Practice Address - Phone:330-870-1145
Practice Address - Fax:330-870-0450
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034390161835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03439016OtherOHIO STATE BOARD OF PHARMACY LICENSE