Provider Demographics
NPI:1164534079
Name:HODGES & SARGENT PHARMACY, LLC
Entity Type:Organization
Organization Name:HODGES & SARGENT PHARMACY, LLC
Other - Org Name:HODGES AND SARGENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARMACIST IN CHARGE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KASHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:512-556-3392
Mailing Address - Street 1:210 S. KEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550
Mailing Address - Country:US
Mailing Address - Phone:512-556-3392
Mailing Address - Fax:512-556-3557
Practice Address - Street 1:210 S. KEY AVE
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550
Practice Address - Country:US
Practice Address - Phone:512-556-3392
Practice Address - Fax:512-556-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX286693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2102008OtherPK
TX143448Medicaid