Provider Demographics
NPI:1376554881
Name:SKINNER & HANG INC
Entity Type:Organization
Organization Name:SKINNER & HANG INC
Other - Org Name:HILLS PRESCRIPTION SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:269-657-4701
Mailing Address - Street 1:404 HAZEN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1040
Mailing Address - Country:US
Mailing Address - Phone:269-657-4701
Mailing Address - Fax:269-657-4553
Practice Address - Street 1:404 HAZEN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1040
Practice Address - Country:US
Practice Address - Phone:269-657-4701
Practice Address - Fax:269-657-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010046143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2302014Medicaid
2039829OtherPK