Hudson Drug Store, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

HUDSON DRUG STORE, LLC

Practice address

600 Nuckolls Rd
Bolivar, TN 38008-1532

Phone

(731) 658-5207

NPI assigned

Nov 16, 2019

Last updated

Apr 16, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jimmy Tucker

Title

Ceo

Phone

(601) 946-1826

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN3 enrollments

Enrollment records 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681603200000",
    "number": "1730724493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10394 TIDWELL RD",
            "city": "BON AQUA",
            "state": "TN",
            "postal_code": "370251567",
            "telephone_number": "601-946-1826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081532",
            "telephone_number": "731-658-5207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUDSON DRUG STORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-16",
        "last_updated": "2023-04-16",
        "certification_date": "2023-04-16",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-946-1826"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ollie Herron, FNP-C, PMHNP-BC
• Sandi Hines
• Tamisha Slayton Hodum, APRN, FNP-C
• Kristy Leann Holloway, RN
• Kayla Jolly Holt, FNP-C
• Jacob Huitt
• Andrew Jackson, PT
• Anita Pearl Johnson, PTA
• Samuel Terry Johnson Jr., M.D.
• Brittany Jones, PT

• Community/Retail Pharmacy in Bolivar, TN
• Providers in Bolivar, TN by specialty
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.