# HODGEMAN COUNTY PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hodgeman County Pharmacy LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306304928
- **Authorized official:** MR. MICHAEL EDWARD COAST (MEMBER)
- **Authorized official phone:** (620) 855-0095

## Contact information

- **Practice address:** 519 MAIN ST, JETMORE, KS 67854-0068
- **Practice address phone:** (620) 357-8305
- **Practice address fax:** (620) 357-6538
- **Mailing address:** PO BOX 782, CIMARRON, KS 67835-0782
- **Mailing address phone:** (620) 855-2055
- **Mailing address fax:** (620) 855-2052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/04/2019
- **Last updated:** 03/04/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1013460922 | NPI | KS |
| 05 | — | 201138190A | — | KS |