Provider Demographics
NPI:1568599249
Name:ALACHUA PHARMACY INC
Entity Type:Organization
Organization Name:ALACHUA PHARMACY INC
Other - Org Name:HOMETOWN PHARMACY - ALACHUA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY-JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAINGER-ROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD RPH
Authorized Official - Phone:352-472-9001
Mailing Address - Street 1:15560 NW US HIGHWAY 441 STE 200
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-5169
Mailing Address - Country:US
Mailing Address - Phone:386-462-2284
Mailing Address - Fax:386-462-5149
Practice Address - Street 1:15560 NW US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5168
Practice Address - Country:US
Practice Address - Phone:386-418-1444
Practice Address - Fax:386-418-1440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MARKETS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000665101OtherFL. MEDICAID DME
FL000665100Medicaid
1097218OtherNCPDP
1097218OtherNCPDP