1760418958 NPI number — HOSKINS DRUG STORE NO 2 INC

Table of content: (NPI 1760418958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760418958 NPI number — HOSKINS DRUG STORE NO 2 INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSKINS DRUG STORE NO 2 INC
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:
Provider Other Organization Name Type Code:
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:
1760418958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37716-3607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-475-4340
Provider Business Mailing Address Fax Number:
865-463-0678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37716-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-475-4340
Provider Business Practice Location Address Fax Number:
865-463-0678
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOSTIC
Authorized Official First Name:
DUDLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
865-457-4340

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0000000194 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 501167 . This is a "DEPT OF LABOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0662682 . This is a "UMWA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 536988000 . This is a "DEPT OD LABOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4403604 . This is a "NABP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3032668 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3520220 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: D04403604 . This is a "JOHNDEER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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