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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1588258834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HODGINS DRUG STORE INC

Provider Business Mailing Address
First Line	:	PO BOX 8987
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-1487
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	:	PAM KAY HAYS
Credential	:
Telephone Number	:	208-882-5536

Provider Enumeration Date	:	02/26/2021
Last Update Date	:	09/24/2024

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Directions to “HODGINS DRUG STORE INC ” Practice Location

Language	Start Address	Practice Location

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