Active NPI
Carlene Marie Kudrick
- Pharmacist
- Champaign, IL
National Provider Identifier
1467766519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 51036228
- Practice address
- 2102 N Prospect Ave
Champaign, IL 61822-1231 - Phone
- (217) 355-3345
- Fax
- (217) 355-3345
- NPI assigned
- Jul 31, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 51036228 | IL | Primary |
Addresses
Primary practice location
2102 N Prospect Ave
Champaign, IL 61822-1231
Mailing address
2102 N Prospect Ave
Champaign, IL 61822-1231
Phone (217) 355-3345
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51036228 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280534400000",
"number": "1467766519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2102 N PROSPECT AVE",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618221231",
"telephone_number": "217-355-3345",
"fax_number": "217-355-3345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2102 N PROSPECT AVE",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618221231",
"telephone_number": "217-355-3345",
"fax_number": "217-355-3345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUDRICK",
"first_name": "CARLENE",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-31",
"last_updated": "2010-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "51036228",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.