Provider Demographics
NPI:1669028742
Name:HITCHCOCK HOMETOWN PHARMACY LLC
Entity Type:Organization
Organization Name:HITCHCOCK HOMETOWN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:832-208-9794
Mailing Address - Street 1:8719 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:HITCHCOCK
Mailing Address - State:TX
Mailing Address - Zip Code:77563-3113
Mailing Address - Country:US
Mailing Address - Phone:409-209-0847
Mailing Address - Fax:409-209-0947
Practice Address - Street 1:8719 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:HITCHCOCK
Practice Address - State:TX
Practice Address - Zip Code:77563-3113
Practice Address - Country:US
Practice Address - Phone:409-209-0847
Practice Address - Fax:409-209-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy