Provider Demographics
NPI:1881782415
Name:HUDAK, MARY E (BPHARM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:HUDAK
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 ROZA VISTA PL
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1234
Mailing Address - Country:US
Mailing Address - Phone:509-374-7113
Mailing Address - Fax:
Practice Address - Street 1:2601 COMMERCE LN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-5801
Practice Address - Country:US
Practice Address - Phone:509-374-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00144971835P0018X
WAPH000146811835P0018X, 183500000X
WAPH60009069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist