Provider Demographics
NPI:1457450314
Name:HUDGINS PHARMACY, INC.
Entity Type:Organization
Organization Name:HUDGINS PHARMACY, INC.
Other - Org Name:HUDGINS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGIN EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-576-7782
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23109-0098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:256 MAIN ST
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109
Practice Address - Country:US
Practice Address - Phone:804-725-2222
Practice Address - Fax:804-725-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010022203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8514879Medicaid
VA8514879Medicaid