Provider Demographics
NPI:1093822884
Name:HITCHCOCK RX INC
Entity Type:Organization
Organization Name:HITCHCOCK RX INC
Other - Org Name:JACK'S DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HITCHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-938-9588
Mailing Address - Street 1:23010 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:WEST BLOCTON
Mailing Address - State:AL
Mailing Address - Zip Code:35184-2672
Mailing Address - Country:US
Mailing Address - Phone:205-938-9588
Mailing Address - Fax:205-938-3035
Practice Address - Street 1:23010 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:WEST BLOCTON
Practice Address - State:AL
Practice Address - Zip Code:35184-2672
Practice Address - Country:US
Practice Address - Phone:205-938-9588
Practice Address - Fax:205-938-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111008333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136622OtherPK
AL142004Medicaid