Provider Demographics
NPI:1942455779
Name:HOMETOWN PHARMACY SERVICES, LLC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY SERVICES, LLC
Other - Org Name:HOMETOWN PHARMACY SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-426-1922
Mailing Address - Street 1:519 W TOWN PLZ
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-5347
Mailing Address - Country:US
Mailing Address - Phone:205-426-1922
Mailing Address - Fax:205-426-1927
Practice Address - Street 1:519 W TOWN PLZ
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-5347
Practice Address - Country:US
Practice Address - Phone:205-426-1922
Practice Address - Fax:205-426-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1132183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118025OtherPK
AL106239Medicaid