Provider Demographics
NPI:1760575070
Name:HOMETOWN PHARMACY INC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY INC
Other - Org Name:HOMETOWN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-942-3313
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-0005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3208 PLANK RD
Practice Address - Street 2:
Practice Address - City:MINEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12956-0337
Practice Address - Country:US
Practice Address - Phone:518-942-3313
Practice Address - Fax:518-942-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0172773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3349924OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY00428937Medicaid
3349924OtherNCPDP PROVIDER IDENTIFICATION NUMBER