Provider Demographics
NPI:1013107242
Name:HOMETOWN PHARMACY 1 LLC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY 1 LLC
Other - Org Name:HOMETOWNE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-764-4256
Mailing Address - Street 1:10157 LEM TURNER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-5044
Mailing Address - Country:US
Mailing Address - Phone:904-764-4256
Mailing Address - Fax:904-764-6873
Practice Address - Street 1:10157 LEM TURNER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5044
Practice Address - Country:US
Practice Address - Phone:904-764-4256
Practice Address - Fax:904-764-6873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH228093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy