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General NPI Number Information
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NPI Number | 1710042551
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Entity Type | Individual
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Provider Name | JERRY DENNIS JUDD R. PH.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 55 FOUNDATION DR
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City | FLEMINGSBURG
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State | KY
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Zip | 41041-9815
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Country | US
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Telephone | 606-849-5077
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Fax |
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Provider Business Mailing Address
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Address Line | 193 U FORBES WAY
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City | FLEMINGSBURG
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State | KY
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Zip | 41041-7284
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Country | US
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Telephone | 606-845-4199
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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 | 007281
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP0004521
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 007544
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License Number State | SC
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