Healthcare Provider Details

I. General information

NPI: 1518977123
Provider Name (Legal Business Name): HUDSON DISCOUNT DRUG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CENTRAL ST
HUDSON NC
28638-2401
US

IV. Provider business mailing address

PO BOX 5047
MERIDIAN MS
39302-5047
US

V. Phone/Fax

Practice location:
  • Phone: 828-728-3561
  • Fax:
Mailing address:
  • Phone: 800-447-4095
  • Fax: 601-482-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05657
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6800476
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier7701322
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier046J2
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS, PAR
# 4
Identifier046KV
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerHIT

VIII. Authorized Official

Name: J REECE
Title or Position: OWNER
Credential:
Phone: 828-728-3561