Healthcare Provider Details

I. General information

NPI: 1639151491
Provider Name (Legal Business Name): HOGAN'S PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W COMMERCIAL ST
LYONS KS
67554-2718
US

IV. Provider business mailing address

120 W COMMERCIAL ST
LYONS KS
67554-2718
US

V. Phone/Fax

Practice location:
  • Phone: 620-257-2061
  • Fax: 620-257-5588
Mailing address:
  • Phone: 620-257-2061
  • Fax: 620-257-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2-09719
License Number StateKS

VIII. Authorized Official

Name: JOLANE POINDEXTER
Title or Position: OWNER
Credential:
Phone: 620-257-2061