Healthcare Provider Details

I. General information

NPI: 1871825000
Provider Name (Legal Business Name): MELISSA A HUDSON R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 PORTLAND AVE
LOUISVILLE KY
40212-1033
US

IV. Provider business mailing address

2215 PORTLAND AVE
LOUISVILLE KY
40212-1033
US

V. Phone/Fax

Practice location:
  • Phone: 502-774-8631
  • Fax:
Mailing address:
  • Phone: 502-774-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number011687
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26021042A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: