MEDICARE: HODGINS DRUG STORE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	065CP	ID
2	332S00000X	Hearing Aid Equipment	H244	ID
3	335E00000X	Prosthetic/Orthotic Supplier	065CP	ID
4	333600000X	Pharmacy	065CP	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	70011	OTHER	ID	BLUE CROSS OF IDAHO RX
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000010014112	OTHER	ID	REGENCE BLUE SHIELD DME
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558364141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HODGINS DRUG STORE, INC.

Provider Business Mailing Address
First Line	:	307 S MAIN ST
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-2913
Country	:	US
Telephone Number	:	208-882-5536
Fax Number	:	208-882-4741

Provider Business Practice Location Address
First Line	:	307 S MAIN ST
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-2913
Country	:	US
Telephone Number	:	208-882-5536
Fax Number	:	208-882-4741

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. PAM HAYS
Credential	:
Telephone Number	:	208-882-5536

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/24/2024

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Directions to “HODGINS DRUG STORE, INC. ” Practice Location

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