Provider Demographics
NPI:1306515309
Name:HUDSON PHARMACY INC
Entity type:Organization
Organization Name:HUDSON PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SANBORN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:517-448-3111
Mailing Address - Street 1:1410 W GANSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-4063
Mailing Address - Country:US
Mailing Address - Phone:517-789-8980
Mailing Address - Fax:517-789-0115
Practice Address - Street 1:325 RAILROAD ST STE D
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-1062
Practice Address - Country:US
Practice Address - Phone:517-448-3111
Practice Address - Fax:517-448-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1174696926Medicaid
0352390001OtherMEDICARE SUPPLIER NUMBER