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General NPI Number Information
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NPI Number | 1245342682
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Entity Type | Individual
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Provider Name | THERESA LYNN JUDKINS R.PH.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 225 E LE CLAIRE RD
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City | ELDRIDGE
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State | IA
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Zip | 52748-1721
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Country | US
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Telephone | 563-285-2001
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Fax | 563-285-5237
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Provider Business Mailing Address
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Address Line | 117 GOLFVIEW DR
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City | ELDRIDGE
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State | IA
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Zip | 52748-2009
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Country | US
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Telephone | 563-285-5286
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Fax | 563-285-5237
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17998
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License Number State | IA
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