Provider Demographics
NPI:1447203484
Name:HASE PHARMACY INC.
Entity Type:Organization
Organization Name:HASE PHARMACY INC.
Other - Org Name:UNION COUNTY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SMILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-833-8545
Mailing Address - Street 1:313 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1241
Mailing Address - Country:US
Mailing Address - Phone:618-833-8545
Mailing Address - Fax:618-833-8547
Practice Address - Street 1:313 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1241
Practice Address - Country:US
Practice Address - Phone:618-833-8545
Practice Address - Fax:618-833-8547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1412547OtherNCPDP #
IL=========001Medicaid
IL1412547OtherNCPDP #