Provider Demographics
NPI:1639151491
Name:HOGAN'S PHARMACY, INC
Entity Type:Organization
Organization Name:HOGAN'S PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOLANE
Authorized Official - Middle Name:
Authorized Official - Last Name:POINDEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-257-2061
Mailing Address - Street 1:120 W COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-2718
Mailing Address - Country:US
Mailing Address - Phone:620-257-2061
Mailing Address - Fax:620-257-5588
Practice Address - Street 1:120 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-2718
Practice Address - Country:US
Practice Address - Phone:620-257-2061
Practice Address - Fax:620-257-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-09719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1709572OtherNABP
KS1709572OtherNABP
KS0794210001Medicare NSC