Provider Demographics
NPI:1114312675
Name:HUDSON PHARMACY CORP
Entity Type:Organization
Organization Name:HUDSON PHARMACY CORP
Other - Org Name:HUDSON PHARMACY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/AO
Authorized Official - Prefix:
Authorized Official - First Name:MAGALY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-448-6965
Mailing Address - Street 1:6508 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2928
Mailing Address - Country:US
Mailing Address - Phone:347-448-6965
Mailing Address - Fax:347-448-6826
Practice Address - Street 1:6508 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2928
Practice Address - Country:US
Practice Address - Phone:347-448-6965
Practice Address - Fax:347-448-6826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
NY0334253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152169OtherPK