Provider Demographics
NPI:1437122504
Name:HUDSON PHARMACY LLC
Entity Type:Organization
Organization Name:HUDSON PHARMACY LLC
Other - Org Name:HUDSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIENUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-988-3800
Mailing Address - Street 1:101 EDDYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IA
Mailing Address - Zip Code:50643-2243
Mailing Address - Country:US
Mailing Address - Phone:319-988-3800
Mailing Address - Fax:319-988-3805
Practice Address - Street 1:101 EDDYSTONE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:IA
Practice Address - Zip Code:50643-2243
Practice Address - Country:US
Practice Address - Phone:319-988-3800
Practice Address - Fax:319-988-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1420333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1437122504Medicaid
1621970OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IA1437122504Medicaid