Provider Demographics
NPI:1659671428
Name:HOMETOWN PHARMACY OF CYNTHIANA PLLC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY OF CYNTHIANA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:859-234-5600
Mailing Address - Street 1:1134 US HWY 27 SOUTH
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7570
Mailing Address - Country:US
Mailing Address - Phone:859-234-5600
Mailing Address - Fax:859-234-5606
Practice Address - Street 1:1134 US HWY 27 SOUTH
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7570
Practice Address - Country:US
Practice Address - Phone:859-234-5600
Practice Address - Fax:859-234-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPENDING332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6724550001Medicare NSC