Provider Demographics
NPI:1760418958
Name:HOSKINS DRUG STORE NO 2 INC
Entity Type:Organization
Organization Name:HOSKINS DRUG STORE NO 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-457-4340
Mailing Address - Street 1:111 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3607
Mailing Address - Country:US
Mailing Address - Phone:865-475-4340
Mailing Address - Fax:865-463-0678
Practice Address - Street 1:111 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3607
Practice Address - Country:US
Practice Address - Phone:865-475-4340
Practice Address - Fax:865-463-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TN00000001943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN501167OtherDEPT OF LABOR
TN0662682OtherUMWA
TN536988000OtherDEPT OD LABOR
TN4403604OtherNABP
TN3032668OtherBCBSTN
TN3520220Medicaid
TND04403604OtherJOHNDEER
TN0662682OtherUMWA
TN536988000OtherDEPT OD LABOR