Healthcare Provider Details

I. General information

NPI: 1083944722
Provider Name (Legal Business Name): WILLIAM RUSSELL JUDD PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOSEPH DR
LEXINGTON KY
40504-3742
US

IV. Provider business mailing address

1 SAINT JOSEPH DR
LEXINGTON KY
40504-3742
US

V. Phone/Fax

Practice location:
  • Phone: 859-330-6349
  • Fax:
Mailing address:
  • Phone: 859-330-6349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number013641
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: