Provider Demographics
NPI:1437560851
Name:HULL'S FAMILY PHARMACY
Entity Type:Organization
Organization Name:HULL'S FAMILY PHARMACY
Other - Org Name:HICKORY FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MGR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-934-2488
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:MS
Mailing Address - Zip Code:39332-0217
Mailing Address - Country:US
Mailing Address - Phone:601-646-0015
Mailing Address - Fax:601-646-0016
Practice Address - Street 1:18205 HWY 80
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:MS
Practice Address - Zip Code:39332
Practice Address - Country:US
Practice Address - Phone:601-646-0015
Practice Address - Fax:601-646-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS133733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04679341Medicaid
2145647OtherPK