Provider Demographics
NPI:1154706943
Name:HUDSON, BURKE TAYLOR (PHARMD)
Entity type:Individual
Prefix:MR
First Name:BURKE
Middle Name:TAYLOR
Last Name:HUDSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3843 SERENA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-0511
Mailing Address - Country:US
Mailing Address - Phone:559-860-8954
Mailing Address - Fax:
Practice Address - Street 1:1300 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-6320
Practice Address - Country:US
Practice Address - Phone:559-673-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist