Provider Demographics
NPI:1043498181
Name:HULL'S PHARMACY INC
Entity Type:Organization
Organization Name:HULL'S PHARMACY INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-693-0033
Mailing Address - Street 1:2000 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:601-693-0062
Practice Address - Street 1:2000 24TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3120
Practice Address - Country:US
Practice Address - Phone:601-693-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS034243336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330246Medicaid
MS2518629OtherNCPDP #
MS2518629OtherNCPDP #
MS1109660001Medicare NSC