Provider Demographics
NPI:1487107678
Name:FABIUS, JUDE
Entity type:Individual
Prefix:
First Name:JUDE
Middle Name:
Last Name:FABIUS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JUDE
Other - Middle Name:
Other - Last Name:FABIUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:603 GRANT CT
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2536
Mailing Address - Country:US
Mailing Address - Phone:972-198-3599
Mailing Address - Fax:
Practice Address - Street 1:603 GRANT CT
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2536
Practice Address - Country:US
Practice Address - Phone:972-298-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist