Provider Demographics
NPI:1235156704
Name:SINCERERX HOMETOWN PHARMACY LLC
Entity Type:Organization
Organization Name:SINCERERX HOMETOWN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-259-7334
Mailing Address - Street 1:715 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648-3511
Mailing Address - Country:US
Mailing Address - Phone:337-738-2614
Mailing Address - Fax:337-738-2523
Practice Address - Street 1:715 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648
Practice Address - Country:US
Practice Address - Phone:337-738-2614
Practice Address - Fax:337-738-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X
LA0453313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1931852OtherNCPDP
1931852OtherOTHER ID NUMBER-COMMERCIAL NUMBER
LA2207768Medicaid
0537670268Medicare NSC