Healthcare Provider Details

I. General information

NPI: 1972685063
Provider Name (Legal Business Name): HUDSON HOLDINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OAK ST
BONNER SPRINGS KS
66012-1049
US

IV. Provider business mailing address

2622 W CENTRAL AVE SUITE 302
WICHITA KS
67203-4969
US

V. Phone/Fax

Practice location:
  • Phone: 913-596-0159
  • Fax: 913-596-0155
Mailing address:
  • Phone: 316-265-3300
  • Fax: 316-265-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2102475
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number210411
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: JERRI M MCNAUGHT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 316-265-3300