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General NPI Number Information
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NPI Number | 1205278686
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Entity Type | Organization
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Legal Business Name | HEWITT DRUG
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 511 N HEWITT DR SUITE 1
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City | HEWITT
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State | TX
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Zip | 76643-3000
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Country | US
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Telephone | 254-666-5000
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Fax | 254-666-5002
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Provider Business Mailing Address
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Address Line | 511 N HEWITT DR SUITE 1
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City | HEWITT
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State | TX
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Zip | 76643-3000
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Country | US
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Telephone | 254-666-5000
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Fax | 254-666-5002
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. MATTHEW DARBY WAGONER
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Credential | RPH
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Telephone | 254-733-3032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 28666
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 28666
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 28666
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28666
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License Number State | TX
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