Provider Demographics
NPI:1245323997
Name:HINES PHARMACY INC.
Entity type:Organization
Organization Name:HINES PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:270-842-4341
Mailing Address - Street 1:1340 KY HIGHWAY 185
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-9691
Mailing Address - Country:US
Mailing Address - Phone:270-842-4341
Mailing Address - Fax:270-842-7893
Practice Address - Street 1:1340 KY HIGHWAY 185
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-9691
Practice Address - Country:US
Practice Address - Phone:270-842-4341
Practice Address - Fax:270-842-7893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP061023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54030176Medicaid
2031910OtherPK
KY54030176Medicaid