Provider Demographics
NPI:1356455414
Name:HOMETOWN BUSINESSES INC.
Entity type:Organization
Organization Name:HOMETOWN BUSINESSES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:I
Authorized Official - Last Name:KLEINHESSELINK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:712-737-4919
Mailing Address - Street 1:512 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041
Mailing Address - Country:US
Mailing Address - Phone:712-737-4919
Mailing Address - Fax:712-737-4969
Practice Address - Street 1:512 8TH ST SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041
Practice Address - Country:US
Practice Address - Phone:712-737-4919
Practice Address - Fax:712-737-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA666333600000X, 3336L0003X, 3336C0004X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0081679Medicaid
IA1356455414Medicaid
IA666OtherPHARMACY LICENSE
1607019OtherNABP#
IA1607019OtherNCPDP
1607019OtherNABP#
IA1607019OtherNCPDP
IA0207810001Medicare ID - Type Unspecified
IA1356455414Medicaid