Provider Demographics
NPI:1578148037
Name:DESKINS HOMETOWN PHARMACY, INC.
Entity Type:Organization
Organization Name:DESKINS HOMETOWN PHARMACY, INC.
Other - Org Name:HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:DESKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:720-352-4721
Mailing Address - Street 1:6912 RIVERSIDE DRIVE SUITE 4
Mailing Address - Street 2:
Mailing Address - City:RAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:24639
Mailing Address - Country:US
Mailing Address - Phone:276-498-4663
Mailing Address - Fax:
Practice Address - Street 1:6912 RIVERSIDE DRIVE SUITE 4
Practice Address - Street 2:
Practice Address - City:RAVEN
Practice Address - State:VA
Practice Address - Zip Code:24639
Practice Address - Country:US
Practice Address - Phone:276-498-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2021130902Medicaid