Provider Demographics
NPI:1629795133
Name:HOMETOWN PHARMACY OF CAMPBELLSVILLE, PLLC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY OF CAMPBELLSVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EADS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:270-789-4663
Mailing Address - Street 1:325 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-2003
Mailing Address - Country:US
Mailing Address - Phone:270-789-4663
Mailing Address - Fax:270-789-4664
Practice Address - Street 1:325 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2003
Practice Address - Country:US
Practice Address - Phone:270-789-4663
Practice Address - Fax:270-789-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy