Provider Demographics
NPI:1548568769
Name:YOUR HOMETOWN PHARMACY INC
Entity Type:Organization
Organization Name:YOUR HOMETOWN PHARMACY INC
Other - Org Name:RELYCARE LTC BELLEVUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-466-7283
Mailing Address - Street 1:1221 N COTNER BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1879
Mailing Address - Country:US
Mailing Address - Phone:402-466-7283
Mailing Address - Fax:402-466-5387
Practice Address - Street 1:7428 EASTPORT PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2348
Practice Address - Country:US
Practice Address - Phone:402-991-7283
Practice Address - Fax:402-991-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29273336L0003X
IA41903336L0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025962200Medicaid
2129273OtherPK