Provider Demographics
NPI:1164925632
Name:HOGDEN ENTERPRISES INC
Entity Type:Organization
Organization Name:HOGDEN ENTERPRISES INC
Other - Org Name:BLAIR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:BEN
Authorized Official - Last Name:MOLSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-989-2919
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:WI
Mailing Address - Zip Code:54616-0186
Mailing Address - Country:US
Mailing Address - Phone:608-989-2919
Mailing Address - Fax:608-989-2837
Practice Address - Street 1:125 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:WI
Practice Address - Zip Code:54616-9367
Practice Address - Country:US
Practice Address - Phone:608-989-2919
Practice Address - Fax:608-989-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73660423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33196800Medicaid