Provider Demographics
NPI:1386969665
Name:HUDSON PHARMACY INC
Entity type:Organization
Organization Name:HUDSON PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CODEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DULMAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-484-1023
Mailing Address - Street 1:8117 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-378-5882
Mailing Address - Fax:727-378-5883
Practice Address - Street 1:8117 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6728
Practice Address - Country:US
Practice Address - Phone:727-378-5882
Practice Address - Fax:727-378-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH245543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124440OtherPK
FL001989900Medicaid