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Organization

HOSTETLER'S STORE INC

Active
Other names
Hostetler's Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
JERRALD L. HOSTETLER (OWNER)
(260) 768-4882
Entity
Organization

Contact information

Practice address
CORNER MAIN AND MORTON ST, SHIPSHEWANA, IN 46565
(260) 768-4882
(260) 768-7238
Mailing address
PO BOX 155, SHIPSHEWANA, IN 46565-0155
(260) 768-4882
(260) 768-7238

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
60003002A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100298300A
IN
01
1522108
NCPDP (NABP) #
IN
Enumeration date
12/29/2005
Last updated
05/27/2008
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