Provider Demographics
NPI:1851327472
Name:HNA INC.
Entity Type:Organization
Organization Name:HNA INC.
Other - Org Name:JUBILEE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-789-3494
Mailing Address - Street 1:524 FRONT ST
Mailing Address - Street 2:PO BOX 1300
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3577
Mailing Address - Country:US
Mailing Address - Phone:307-789-3494
Mailing Address - Fax:307-789-5554
Practice Address - Street 1:524 FRONT ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3577
Practice Address - Country:US
Practice Address - Phone:307-789-3494
Practice Address - Fax:307-789-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5202635333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========002Medicaid
UT=========002Medicaid