Provider Demographics
NPI:1639218381
Name:HOMETOWN PHARMACY LLC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:QUINLAN
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-859-5633
Mailing Address - Street 1:1805 ROUTE 206 UNIT 9
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-3558
Mailing Address - Country:US
Mailing Address - Phone:609-859-5633
Mailing Address - Fax:
Practice Address - Street 1:1805 ROUTE 206 UNIT 9
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-3558
Practice Address - Country:US
Practice Address - Phone:609-859-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006440003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3192351OtherNAPB
NJ0049221Medicaid
3192351OtherNAPB