Provider Demographics
NPI:1114224193
Name:HOMETOWN VILLAGE PHARMACY LLC
Entity Type:Organization
Organization Name:HOMETOWN VILLAGE PHARMACY LLC
Other - Org Name:HOMETOWN VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-668-1900
Mailing Address - Street 1:220 CLAREMONT AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-4460
Mailing Address - Country:US
Mailing Address - Phone:570-668-1900
Mailing Address - Fax:570-668-8812
Practice Address - Street 1:220 CLAREMONT AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-4460
Practice Address - Country:US
Practice Address - Phone:570-668-1900
Practice Address - Fax:570-668-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
PAPP4821243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025609390001Medicaid
2129588OtherPK