=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003198334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACINTA M HUDAK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2011
-----------------------------------------------------
Last Update Date | 09/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1855 S 5TH ST
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-4925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-791-7796
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6139 POND VIEW TER
-----------------------------------------------------
City | BATH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18014-9090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-837-1406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP041698L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------