Provider Demographics
NPI:1710318274
Name:HOMERX HEALTHCARE LLC
Entity Type:Organization
Organization Name:HOMERX HEALTHCARE LLC
Other - Org Name:HOMERX HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FOIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-671-9000
Mailing Address - Street 1:PO BOX 1569
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-1569
Mailing Address - Country:US
Mailing Address - Phone:910-671-9000
Mailing Address - Fax:
Practice Address - Street 1:707 FARRINGDOM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-0007
Practice Address - Country:US
Practice Address - Phone:910-671-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC117573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143235OtherPK