Provider Demographics
NPI:1790006724
Name:HOMETOWN PHARMACY LLC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY LLC
Other - Org Name:HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-294-6021
Mailing Address - Street 1:27118 HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:70462-7979
Mailing Address - Country:US
Mailing Address - Phone:225-294-6021
Mailing Address - Fax:225-294-6026
Practice Address - Street 1:27118 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:LA
Practice Address - Zip Code:70462-7979
Practice Address - Country:US
Practice Address - Phone:225-294-6021
Practice Address - Fax:225-294-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY006265-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2200151Medicaid
2125694OtherPK
1174802078Medicare NSC