Provider Demographics
NPI:1477659035
Name:CHARLOTTE'S HOMETOWN PHARMACY
Entity type:Organization
Organization Name:CHARLOTTE'S HOMETOWN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:BATEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:615-789-9393
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TN
Mailing Address - Zip Code:37036-0518
Mailing Address - Country:US
Mailing Address - Phone:615-789-9393
Mailing Address - Fax:615-789-9330
Practice Address - Street 1:3369 HIGHWAY 48 N
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:TN
Practice Address - Zip Code:37036-4853
Practice Address - Country:US
Practice Address - Phone:615-789-9393
Practice Address - Fax:615-789-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045904Medicaid