Provider Demographics
NPI:1720120173
Name:HOMETOWN PHARMACY INC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY INC
Other - Org Name:HOMETOWN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LECHAK
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:501-760-5667
Mailing Address - Street 1:2228 ALBERT PIKE RD STE B
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4089
Mailing Address - Country:US
Mailing Address - Phone:501-760-5667
Mailing Address - Fax:501-760-5744
Practice Address - Street 1:2228 ALBERT PIKE RD STE B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4089
Practice Address - Country:US
Practice Address - Phone:501-760-5667
Practice Address - Fax:501-760-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
ARAR20401333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155048407Medicaid
1989577OtherPK