Provider Demographics
NPI:1346394442
Name:HODGES PHARMACY
Entity Type:Organization
Organization Name:HODGES PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-394-2602
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:LEAKESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39451-0699
Mailing Address - Country:US
Mailing Address - Phone:601-394-2602
Mailing Address - Fax:601-394-5501
Practice Address - Street 1:411 SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451-8909
Practice Address - Country:US
Practice Address - Phone:601-394-2602
Practice Address - Fax:601-394-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00032417Medicaid
MS00440631Medicaid
MS00032417Medicaid
MS1251800001Medicare ID - Type Unspecified