Provider Demographics
NPI:1578678827
Name:HUDSON PHARMACY, INC.
Entity type:Organization
Organization Name:HUDSON PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY AND STORE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KENDRICK
Authorized Official - Last Name:WAITS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-792-4467
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:PRENTISS
Mailing Address - State:MS
Mailing Address - Zip Code:39474-0658
Mailing Address - Country:US
Mailing Address - Phone:601-792-4467
Mailing Address - Fax:601-792-8191
Practice Address - Street 1:1635 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:PRENTISS
Practice Address - State:MS
Practice Address - Zip Code:39474
Practice Address - Country:US
Practice Address - Phone:601-792-4467
Practice Address - Fax:601-792-8191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS001333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00032522Medicaid