Organization
HODGEMAN COUNTY PHARMACY LLC
Active
Other names
Hodgeman County Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL EDWARD COAST (MEMBER)
(620) 855-0095
Entity
Organization
Contact information
Practice address
519 MAIN ST, JETMORE, KS 67854-0068
(620) 357-8305
(620) 357-6538
Mailing address
PO BOX 782, CIMARRON, KS 67835-0782
(620) 855-2055
(620) 855-2052
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013460922
NPI
KS
05
—
201138190A
—
KS
Enumeration date
03/04/2019
Last updated
03/04/2019
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