Provider Demographics
NPI:1518679554
Name:HOMETOWN LTC-RX
Entity Type:Organization
Organization Name:HOMETOWN LTC-RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-765-5055
Mailing Address - Street 1:PO BOX 2396
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-2396
Mailing Address - Country:US
Mailing Address - Phone:601-765-5055
Mailing Address - Fax:601-765-8544
Practice Address - Street 1:801 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-4214
Practice Address - Country:US
Practice Address - Phone:601-765-5055
Practice Address - Fax:601-765-8544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy