Provider Demographics
NPI:1669508065
Name:HUTCHINSON DRUG STORE
Entity Type:Organization
Organization Name:HUTCHINSON DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:859-252-3554
Mailing Address - Street 1:401 W MAIN ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1640
Practice Address - Country:US
Practice Address - Phone:859-252-3554
Practice Address - Fax:859-252-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYPO08703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1805944OtherOTHER ID NUMBER
1805944OtherOTHER ID NUMBER-COMMERCIAL NUMBER
KY54001763Medicaid