Healthcare Provider Details

I. General information

NPI: 1811666373
Provider Name (Legal Business Name): HUDSON PRIEBE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
DUBUQUE IA
52001-6814
US

IV. Provider business mailing address

1612 RADFORD RD UNIT 9
DUBUQUE IA
52002-2125
US

V. Phone/Fax

Practice location:
  • Phone: 563-588-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23853
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: