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General NPI Number Information
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NPI Number | 1790762938
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Entity Type | Organization
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Legal Business Name | HOSTETLER'S STORE INC
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | CORNER MAIN AND MORTON ST
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City | SHIPSHEWANA
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State | IN
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Zip | 46565
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Country | US
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Telephone | 260-768-4882
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Fax | 260-768-7238
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Provider Business Mailing Address
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Address Line | PO BOX 155
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City | SHIPSHEWANA
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State | IN
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Zip | 46565-0155
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Country | US
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Telephone | 260-768-4882
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Fax | 260-768-7238
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Authorized Official
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Title or Position | OWNER
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Name | JERRALD L. HOSTETLER
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Credential |
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Telephone | 260-768-4882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 60003002A
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License Number State | IN
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