Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Nutrition, Education |
133NN1002X | |||
Clinic/Center |
261Q00000X | |||
Clinical Medical Laboratory |
291U00000X | 69 | Clinical Laboratory |
| NPI Number | 1407851769 |
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| LBN Legal business name | JUDYS DRUG STORE INC | ||||||||||||
| Authorized official | DARIN JUDY - (VICE PRESIDENT) | ||||||||||||
| Entity | Organization | ||||||||||||
| Organization subpart 1 | No | ||||||||||||
| Enumeration date | 06/14/2005 | ||||||||||||
| Last updated | 04/24/2012 - About 14 years ago | ||||||||||||
| Identifiers |
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