Provider Demographics
NPI:1588258834
Name:HODGINS DRUG STORE INC
Entity type:Organization
Organization Name:HODGINS DRUG STORE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-882-5536
Mailing Address - Street 1:PO BOX 8987
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-1487
Mailing Address - Country:US
Mailing Address - Phone:208-882-5536
Mailing Address - Fax:208-882-4741
Practice Address - Street 1:307 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2913
Practice Address - Country:US
Practice Address - Phone:208-882-5536
Practice Address - Fax:208-882-4741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HODGINS DRUG STORE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-26
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy