Active NPI
Queonja Dudley, PHARMD
- Geriatric Pharmacist
- Southfield, MI
National Provider Identifier
1972380806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Pharmacist
- License
- 5302046500
- Practice address
- 24463 W 10 Mile Rd
Southfield, MI 48033-2931 - Phone
- (248) 727-8822
- NPI assigned
- Sep 13, 2023
- 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 |
|---|---|---|---|---|
| Geriatric Pharmacist | 1835G0303X | 5302046500 | MI | Primary |
Addresses
Primary practice location
24463 W 10 Mile Rd
Southfield, MI 48033-2931
Mailing address
PO Box 856
Novi, MI 48376-0856
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302046500 | MI | MD | Geriatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694563200000",
"number": "1972380806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 856",
"city": "NOVI",
"state": "MI",
"postal_code": "483760856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24463 W 10 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480332931",
"telephone_number": "248-727-8822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUDLEY",
"first_name": "QUEONJA",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-13",
"last_updated": "2023-09-13",
"certification_date": "2023-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "1835G0303X",
"taxonomy_group": "",
"desc": "Pharmacist, Geriatric",
"state": "MI",
"license": "5302046500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.