Provider Demographics
NPI:1730724493
Name:HUDSON DRUG STORE, LLC
Entity type:Organization
Organization Name:HUDSON DRUG STORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-946-1826
Mailing Address - Street 1:10394 TIDWELL RD
Mailing Address - Street 2:
Mailing Address - City:BON AQUA
Mailing Address - State:TN
Mailing Address - Zip Code:37025-1567
Mailing Address - Country:US
Mailing Address - Phone:601-946-1826
Mailing Address - Fax:
Practice Address - Street 1:600 NUCKOLLS RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1532
Practice Address - Country:US
Practice Address - Phone:731-658-5207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-16
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy