Provider Demographics
NPI:1245300201
Name:HOMER CITY PHARMACY, INC.
Entity type:Organization
Organization Name:HOMER CITY PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MATEER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-639-9022
Mailing Address - Street 1:237 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SALTSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15681-1131
Mailing Address - Country:US
Mailing Address - Phone:724-639-9022
Mailing Address - Fax:724-639-3535
Practice Address - Street 1:237 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SALTSBURG
Practice Address - State:PA
Practice Address - Zip Code:15681-1131
Practice Address - Country:US
Practice Address - Phone:724-639-9022
Practice Address - Fax:724-639-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014014820002Medicaid