MEDICARE: DR. GOPI HUDKA PHARM D, R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH233721	MA
2	183500000X	Pharmacist	28RI03477400	NJ

General Provider Information

NPI Number	:	1366701278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GOPI HUDKA PHARM D, R.PH

Provider Business Mailing Address
First Line	:	419 UNION ST
Second Line	:
City	:	BOONTON
State	:	NJ
Zip	:	07005-1857
Country	:	US
Telephone Number	:	508-425-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707 MORRIS AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-4823
Country	:	US
Telephone Number	:	908-258-7002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	05/11/2012

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