Provider Demographics
NPI:1215925714
Name:HUDSON, ROBERT LOUIS (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LOUIS
Last Name:HUDSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 CAROLINA AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2306
Mailing Address - Country:US
Mailing Address - Phone:540-353-1442
Mailing Address - Fax:540-265-2154
Practice Address - Street 1:327 HERSHBERGER RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1983
Practice Address - Country:US
Practice Address - Phone:540-265-2153
Practice Address - Fax:540-265-2154
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202003423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202003423OtherBOARD OF PHARMACY PERMIT