Provider Demographics
NPI:1225130651
Name:HOPPS COLONIAL PHARMACY
Entity Type:Organization
Organization Name:HOPPS COLONIAL PHARMACY
Other - Org Name:CDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWDEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-542-7770
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49252-0453
Mailing Address - Country:US
Mailing Address - Phone:517-542-7770
Mailing Address - Fax:517-542-7771
Practice Address - Street 1:111 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MI
Practice Address - Zip Code:49252-9355
Practice Address - Country:US
Practice Address - Phone:517-542-7770
Practice Address - Fax:517-542-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010076633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2364773Medicaid
2046234OtherPK
6067380002Medicare NSC