Provider Demographics
NPI:1972062420
Name:HOMETOWN PHARMACY OF CAMPBELLSVILLE, PLLC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY OF CAMPBELLSVILLE, PLLC
Other - Org Name:HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EADS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-789-4663
Mailing Address - Street 1:325 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-2003
Mailing Address - Country:US
Mailing Address - Phone:270-789-4663
Mailing Address - Fax:
Practice Address - Street 1:325 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2003
Practice Address - Country:US
Practice Address - Phone:270-465-1513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies