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NPI Code Detail

MEDICARE: GEORGE RANDAL HUDSON JR.

MEDICARE: GEORGE RANDAL HUDSON JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist22409AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477271252
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE RANDAL HUDSON JR.
Provider Business Mailing Address
First Line : 3368 FARING RD
Second Line :
City : MOUNTAIN BRK
State : AL
Zip : 35223-2002
Country : US
Telephone Number : 205-960-8615
Fax Number :
Provider Business Practice Location Address
First Line : 101 DOUG BAKER BLVD
Second Line :
City : HOOVER
State : AL
Zip : 35242-2675
Country : US
Telephone Number : 205-437-9467
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2022
Last Update Date : 08/18/2022

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