Provider Demographics
NPI:1124326731
Name:HUDSON, MICHELLE
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5706
Mailing Address - Country:US
Mailing Address - Phone:843-815-3867
Mailing Address - Fax:
Practice Address - Street 1:6315 JONATHAN FRANCIS SR RD
Practice Address - Street 2:
Practice Address - City:ST. HELENA IS
Practice Address - State:SC
Practice Address - Zip Code:29920-5310
Practice Address - Country:US
Practice Address - Phone:843-322-1872
Practice Address - Fax:843-838-7935
Is Sole Proprietor?:No
Enumeration Date:2011-03-05
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist