1164534079 NPI number — HODGES & SARGENT PHARMACY, LLC

Table of content: (NPI 1164534079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164534079 NPI number — HODGES & SARGENT PHARMACY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HODGES & SARGENT PHARMACY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HODGES AND SARGENT PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164534079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 S. KEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAMPASAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-556-3392
Provider Business Mailing Address Fax Number:
512-556-3557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 S. KEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMPASAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-556-3392
Provider Business Practice Location Address Fax Number:
512-556-3557
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
KASHA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PARMACIST IN CHARGE/OWNER
Authorized Official Telephone Number:
512-556-3392

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 28669 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2102008 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 143448 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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