Provider Demographics
NPI:1467694950
Name:HOMETOWN PHARMACY
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY
Other - Org Name:HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C0-OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:251-843-2400
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:69 W MAIN ST
Mailing Address - City:GILBERTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:36908-0282
Mailing Address - Country:US
Mailing Address - Phone:251-843-2400
Mailing Address - Fax:251-843-2402
Practice Address - Street 1:69 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GILBERTOWN
Practice Address - State:AL
Practice Address - Zip Code:36908-2045
Practice Address - Country:US
Practice Address - Phone:251-843-2400
Practice Address - Fax:251-843-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
AL1132453336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119608OtherPK
AL109384Medicaid
0135904OtherNCPDP PROVIDER IDENTIFICATION NUMBER