Provider Demographics
NPI:1932203973
Name:HIXSON DRUGS LLC
Entity Type:Organization
Organization Name:HIXSON DRUGS LLC
Other - Org Name:HIXSON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-581-7777
Mailing Address - Street 1:604A E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8912
Mailing Address - Country:US
Mailing Address - Phone:417-581-7777
Mailing Address - Fax:417-581-8152
Practice Address - Street 1:604A E SOUTH ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8912
Practice Address - Country:US
Practice Address - Phone:417-581-7777
Practice Address - Fax:417-581-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120224413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137835OtherPK
MO600129001Medicaid