Provider Demographics
NPI:1598108847
Name:HOMETOWN LTC PHARMACY INC
Entity Type:Organization
Organization Name:HOMETOWN LTC PHARMACY INC
Other - Org Name:HOMETOWN LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-928-2200
Mailing Address - Street 1:1450 W MCCOY LN STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1059
Mailing Address - Country:US
Mailing Address - Phone:805-928-2200
Mailing Address - Fax:805-928-6200
Practice Address - Street 1:1450 W MCCOY LN STE B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1059
Practice Address - Country:US
Practice Address - Phone:805-928-2200
Practice Address - Fax:805-928-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332800000X, 332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336S0011X
CAPHY512793336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598108847Medicaid
2139957OtherPK
CA1598108847Medicaid