Provider Demographics
NPI:1508189374
Name:WEST-HUDSON LLC
Entity Type:Organization
Organization Name:WEST-HUDSON LLC
Other - Org Name:EAGLE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-582-5363
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-0844
Mailing Address - Country:US
Mailing Address - Phone:254-582-5363
Mailing Address - Fax:254-582-7429
Practice Address - Street 1:101 JANE LN
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2673
Practice Address - Country:US
Practice Address - Phone:254-582-5363
Practice Address - Fax:254-582-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
TX268203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124047OtherPK
TX146109Medicaid
6411310001Medicare NSC