Provider Demographics
NPI:1649875063
Name:KILGORE, JUDSON (PHARMD)
Entity type:Individual
Prefix:
First Name:JUDSON
Middle Name:
Last Name:KILGORE
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 1:879 FORT DALE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3511
Mailing Address - Country:US
Mailing Address - Phone:334-382-3146
Mailing Address - Fax:
Practice Address - Street 1:879 FORT DALE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3511
Practice Address - Country:US
Practice Address - Phone:334-382-3146
Practice Address - Fax:334-382-6311
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1787911183500000X
AL20809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist