Provider Demographics
NPI:1962837039
Name:HUGO FAMILY PHARMACY
Entity Type:Organization
Organization Name:HUGO FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KORINNE
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-326-8337
Mailing Address - Street 1:420 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4021
Mailing Address - Country:US
Mailing Address - Phone:580-326-8337
Mailing Address - Fax:580-326-8338
Practice Address - Street 1:420 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4021
Practice Address - Country:US
Practice Address - Phone:580-326-8337
Practice Address - Fax:580-326-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK310400000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200511730AMedicaid