Provider Demographics
NPI:1043700933
Name:HOOKS DIABETES & MEDICINE CLINIC
Entity Type:Organization
Organization Name:HOOKS DIABETES & MEDICINE CLINIC
Other - Org Name:HOOKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NCPDP COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-590-0808
Mailing Address - Street 1:200 RITTENHOUSE CIRCLE
Mailing Address - Street 2:EAST BUILDING STE 5
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007
Mailing Address - Country:US
Mailing Address - Phone:888-590-0808
Mailing Address - Fax:866-740-4689
Practice Address - Street 1:2610 TRACELAND DRIVE
Practice Address - Street 2:STE A
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:888-590-0808
Practice Address - Fax:866-740-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867568332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site