Provider Demographics
NPI:1295811156
Name:HOOPER DRUG STORE
Entity type:Organization
Organization Name:HOOPER DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-658-2121
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:WHITWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37397-0129
Mailing Address - Country:US
Mailing Address - Phone:423-658-2121
Mailing Address - Fax:423-658-7600
Practice Address - Street 1:325 E. SPRING STREET PO 129
Practice Address - Street 2:
Practice Address - City:WHITWELL
Practice Address - State:TN
Practice Address - Zip Code:37397-0129
Practice Address - Country:US
Practice Address - Phone:423-658-2121
Practice Address - Fax:423-658-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3520505Medicaid
TN3520505Medicaid