Provider Demographics
NPI:1679824031
Name:OAK HILL HOMETOWN PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:OAK HILL HOMETOWN PHARMACY INCORPORATED
Other - Org Name:OAK HILL HOMETOWN PHARMACY INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-465-0222
Mailing Address - Street 1:PO BOX 1468
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-1468
Mailing Address - Country:US
Mailing Address - Phone:304-465-0222
Mailing Address - Fax:304-465-0228
Practice Address - Street 1:819 MAIN ST E
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3123
Practice Address - Country:US
Practice Address - Phone:304-465-0222
Practice Address - Fax:304-465-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05524353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5055719OtherNCPDP PROVIDER IDENTIFICATION NUMBER