Provider Demographics
NPI:1972685063
Name:HUDSON HOLDINGS, INC.
Entity type:Organization
Organization Name:HUDSON HOLDINGS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCNAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-265-3300
Mailing Address - Street 1:2622 W CENTRAL AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4969
Mailing Address - Country:US
Mailing Address - Phone:316-265-3300
Mailing Address - Fax:316-265-3304
Practice Address - Street 1:111 OAK ST
Practice Address - Street 2:
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-1049
Practice Address - Country:US
Practice Address - Phone:913-596-0159
Practice Address - Fax:913-596-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X
KS21024753336L0003X
KS2104113336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100435330FMedicaid
KS100435330EMedicaid
2027795OtherPK
KS100435330FMedicaid