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NPI Code Detail

MEDICARE: MR. JAMES HUDSON

MEDICARE: MR. JAMES HUDSON
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
1183500000XPharmacist051-228776IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1051-288776OTHERILIL PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number : 1790066777
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES HUDSON
Provider Business Mailing Address
First Line : 1400 E LAKE COOK RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-8217
Country : US
Telephone Number : 847-465-0951
Fax Number : 224-676-5365
Provider Business Practice Location Address
First Line : 1400 E LAKE COOK RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-8217
Country : US
Telephone Number : 847-465-0951
Fax Number : 224-676-5365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2011
Last Update Date : 09/02/2011

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