Provider Demographics
NPI:1114270089
Name:CUDD, DELANA RAE (RPH)
Entity type:Individual
Prefix:MRS
First Name:DELANA
Middle Name:RAE
Last Name:CUDD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:DELANA
Other - Middle Name:RAE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2219 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3340
Mailing Address - Country:US
Mailing Address - Phone:843-488-4400
Mailing Address - Fax:
Practice Address - Street 1:2219 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3340
Practice Address - Country:US
Practice Address - Phone:843-488-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8985183500000X
SC12418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist