Provider Demographics
NPI:1982978516
Name:HEDRICK MEDICAL CENTER PHCY
Entity Type:Organization
Organization Name:HEDRICK MEDICAL CENTER PHCY
Other - Org Name:HMC RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:660-214-8265
Mailing Address - Street 1:2799 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-2902
Mailing Address - Country:US
Mailing Address - Phone:660-214-8260
Mailing Address - Fax:660-214-8266
Practice Address - Street 1:2799 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-2902
Practice Address - Country:US
Practice Address - Phone:660-214-8260
Practice Address - Fax:660-214-8266
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEDRICK MEDICAL CENTER PHCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-29
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
MO0059823336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2617439OtherNCPDP PROVIDER IDENTIFICATION NUMBER