Provider Demographics
NPI:1952493462
Name:HOME TOWN PHARMACY INC.
Entity Type:Organization
Organization Name:HOME TOWN PHARMACY INC.
Other - Org Name:OLD TOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:423-626-2344
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879
Mailing Address - Country:US
Mailing Address - Phone:423-626-2344
Mailing Address - Fax:423-626-2877
Practice Address - Street 1:1410 N. BROADSTREET
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879
Practice Address - Country:US
Practice Address - Phone:423-626-2344
Practice Address - Fax:423-626-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35203336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4434180OtherNCPDP NUMBER
TN4118550001Medicare NSC