Provider Demographics
NPI:1538437405
Name:JUDSON, LYNN EVENDEN (PHARMD, CGP)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:EVENDEN
Last Name:JUDSON
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2143
Mailing Address - Country:US
Mailing Address - Phone:720-212-5627
Mailing Address - Fax:
Practice Address - Street 1:114 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2143
Practice Address - Country:US
Practice Address - Phone:720-212-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14727183500000X
CO16190183500000X
NC20932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist