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General NPI Number Information
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NPI Number | 1770687782
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Entity Type | Organization
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Legal Business Name | HIDEG PHARMACY INC
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 8601 W MAIN ST STE 104
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City | BELLEVILLE
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State | IL
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Zip | 62223-1788
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Country | US
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Telephone | 618-398-4400
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Fax | 618-398-4401
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Provider Business Mailing Address
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Address Line | 8601 W MAIN ST STE 104
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City | BELLEVILLE
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State | IL
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Zip | 62223-1788
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Country | US
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Telephone | 618-398-4400
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Fax | 618-398-4401
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL DAY
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Credential | PHARMD
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Telephone | 618-398-4400
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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 | 054009963
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054009963
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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