Provider Demographics
NPI:1356973804
Name:HOME TOWN MARKET INC
Entity type:Organization
Organization Name:HOME TOWN MARKET INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST, PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JARVENE
Authorized Official - Last Name:SHACKELFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-591-5234
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-0045
Mailing Address - Country:US
Mailing Address - Phone:662-591-5234
Mailing Address - Fax:662-591-5229
Practice Address - Street 1:7122 WILL ROBBINS HWY
Practice Address - Street 2:
Practice Address - City:NETTLETON
Practice Address - State:MS
Practice Address - Zip Code:38858-5918
Practice Address - Country:US
Practice Address - Phone:662-591-5234
Practice Address - Fax:662-591-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy