Provider Demographics
NPI:1073600268
Name:HUJO INC
Entity Type:Organization
Organization Name:HUJO INC
Other - Org Name:SCOTTYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLOM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-366-4024
Mailing Address - Street 1:719 W ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-2403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:719 W ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2403
Practice Address - Country:US
Practice Address - Phone:502-366-4024
Practice Address - Fax:502-366-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06733333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1827229OtherOTHER ID NUMBER-COMMERCIAL NUMBER
KY54003041Medicaid
1827229OtherOTHER ID NUMBER-COMMERCIAL NUMBER