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General NPI Number Information
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NPI Number | 1306304928
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Entity Type | Organization
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Legal Business Name | HODGEMAN COUNTY PHARMACY LLC
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 03/04/2019
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Provider Practice Location Address
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Address Line | 519 MAIN ST
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City | JETMORE
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State | KS
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Zip | 67854-0068
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Country | US
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Telephone | 620-357-8305
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Fax | 620-357-6538
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Provider Business Mailing Address
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Address Line | PO BOX 782
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City | CIMARRON
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State | KS
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Zip | 67835-0782
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Country | US
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Telephone | 620-855-2055
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Fax | 620-855-2052
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Authorized Official
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Title or Position | MEMBER
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Name | MR. MICHAEL EDWARD COAST
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Credential |
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Telephone | 620-855-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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