Provider Demographics
NPI:1407484199
Name:HOMETOWN PHARMACY OF HAZARD LLC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY OF HAZARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-275-1239
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:HYDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41749-0289
Mailing Address - Country:US
Mailing Address - Phone:606-551-1110
Mailing Address - Fax:606-551-1131
Practice Address - Street 1:221 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1920
Practice Address - Country:US
Practice Address - Phone:606-551-1110
Practice Address - Fax:606-551-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy