MEDICARE: DAVID JUDY RPH

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	11827	GA

General Provider Information

NPI Number	:	1548534431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JUDY RPH

Provider Business Mailing Address
First Line	:	2512 TOBACCO RD
Second Line	:
City	:	HEPHZIBAH
State	:	GA
Zip	:	30815-7099
Country	:	US
Telephone Number	:	706-790-0917
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 TOBACCO RD
Second Line	:
City	:	HEPHZIBAH
State	:	GA
Zip	:	30815-7099
Country	:	US
Telephone Number	:	706-790-0917
Fax Number	:

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

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	02/24/2012

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