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General NPI Number Information
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NPI Number | 1396211025
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Entity Type | Individual
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Provider Name | VITA JUDKINS R.PH., BCACP
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Gender | Female
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Dates
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Enumeration Date | 10/20/2018
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Last Update Date | 10/20/2018
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Provider Practice Location Address
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Address Line | 240 RENAISSANCE PKWAY NE UNIT 116
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone | 212-397-5007
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Fax |
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Provider Business Mailing Address
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Address Line | 240 RENAISSANCE PKWY NE APT 116
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City | ATLANTA
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State | GA
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Zip | 30308-2349
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Country | US
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Telephone | 212-397-5007
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Fax |
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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 | 15609
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License Number State | GA
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