Provider Demographics
NPI:1447315411
Name:HUDSPETH CENTER PHARMACY
Entity type:Organization
Organization Name:HUDSPETH CENTER PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:FEIGLER
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-664-6350
Mailing Address - Street 1:PO BOX 127B
Mailing Address - Street 2:
Mailing Address - City:WHITFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39193-1032
Mailing Address - Country:US
Mailing Address - Phone:601-664-6350
Mailing Address - Fax:601-664-6325
Practice Address - Street 1:100 HUDSPETH CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193
Practice Address - Country:US
Practice Address - Phone:601-664-6350
Practice Address - Fax:601-664-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MS013430313336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00095184Medicaid
2045434OtherPK