Provider Demographics
NPI:1265828750
Name:ANDERSON HOMETOWN PHARMACY, LLC
Entity Type:Organization
Organization Name:ANDERSON HOMETOWN PHARMACY, LLC
Other - Org Name:ANDERSON HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:ASHLOCK
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-243-6337
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551-0088
Mailing Address - Country:US
Mailing Address - Phone:931-243-6337
Mailing Address - Fax:931-243-6336
Practice Address - Street 1:151 MCARTHUR AVENUE
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551
Practice Address - Country:US
Practice Address - Phone:931-243-6337
Practice Address - Fax:931-243-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5550OtherPHARMACY LICENSE