Healthcare Provider Details

I. General information

NPI: 1306515309
Provider Name (Legal Business Name): HUDSON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 RAILROAD ST STE D
HUDSON MI
49247-1062
US

IV. Provider business mailing address

1410 W GANSON ST
JACKSON MI
49202-4063
US

V. Phone/Fax

Practice location:
  • Phone: 517-448-3111
  • Fax: 517-448-5892
Mailing address:
  • Phone: 517-789-8980
  • Fax: 517-789-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOANN MARIE SANBORN
Title or Position: VP OPERATIONS
Credential: RPH
Phone: 517-448-3111