Provider Demographics
NPI:1194133215
Name:HUDSON, JILL
Entity type:Individual
Prefix:MRS
First Name:JILL
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 1:1226 E DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-8856
Mailing Address - Country:US
Mailing Address - Phone:336-626-5675
Mailing Address - Fax:336-626-7363
Practice Address - Street 1:1226 E DIXIE DR
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8856
Practice Address - Country:US
Practice Address - Phone:336-626-5675
Practice Address - Fax:336-626-7363
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist