MEDICARE: MR. JAMES HUDSON

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
1	183500000X	Pharmacist	051-228776	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051-288776	OTHER	IL	IL PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1790066777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES HUDSON

Provider Business Mailing Address
First Line	:	1400 E LAKE COOK RD
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-8217
Country	:	US
Telephone Number	:	847-465-0951
Fax Number	:	224-676-5365

Provider Business Practice Location Address
First Line	:	1400 E LAKE COOK RD
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-8217
Country	:	US
Telephone Number	:	847-465-0951
Fax Number	:	224-676-5365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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Directions to “ MR. JAMES HUDSON ” Practice Location

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