Hostetler'S Store Inc
Organization Active NPI Pharmacist · Shipshewana, IN
NPI 1790762938 · NPPES record last updated May 27, 2008
Key facts
- NPI
- 1790762938
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacist 183500000X
- License
- 60003002A (IN)
- Legal business name
- HOSTETLER'S STORE INC
- Practice address
- Corner Main and Morton St
Shipshewana, IN 46565 - Phone
- (260) 768-4882
- Fax
- (260) 768-7238
- NPI assigned
- Dec 29, 2005
- Organization subpart
- No
Authorized official
- Name
- Jerrald L. Hostetler
- Title
- Owner
- Phone
- (260) 768-4882
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | 60003002A | IN | Yes |
Addresses
Primary practice location
Corner Main and Morton St
Shipshewana, IN 46565
Mailing address
PO Box 155
Shipshewana, IN 46565-0155
Phone (260) 768-4882
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1522108 | Other | IN | NCPDP (NABP) # |
| 100298300A | Medicaid | IN |
Other names
- Hostetler's Pharmacy
Other providers in Shipshewana, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.