Provider Demographics
NPI:1790320018
Name:HOMETOWN PHARMACY OF WINCHESTER, PLLC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY OF WINCHESTER, PLLC
Other - Org Name:HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, RPH
Authorized Official - Prefix:
Authorized Official - First Name:BIJALKUMAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-759-2102
Mailing Address - Street 1:200 CODELLA DR STE C
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-7101
Mailing Address - Country:US
Mailing Address - Phone:859-759-2102
Mailing Address - Fax:859-759-2104
Practice Address - Street 1:200 CODELLA DR STE C
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-7101
Practice Address - Country:US
Practice Address - Phone:859-940-2950
Practice Address - Fax:877-900-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP08095OtherPHARMACY PERMIT