Provider Demographics
NPI:1356498539
Name:APOTHECARY OF HUGO INC
Entity Type:Organization
Organization Name:APOTHECARY OF HUGO INC
Other - Org Name:CITY DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-326-3301
Mailing Address - Street 1:116 E DUKE ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4033
Mailing Address - Country:US
Mailing Address - Phone:580-326-3301
Mailing Address - Fax:580-326-9494
Practice Address - Street 1:116 E DUKE ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4033
Practice Address - Country:US
Practice Address - Phone:580-326-3301
Practice Address - Fax:580-326-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
OK39-74983336C0003X
OK391223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072815OtherPK
OK100239950AMedicaid
2072815OtherPK