Provider Demographics
NPI:1740297472
Name:HOMETOWN UMATILLA LLC
Entity type:Organization
Organization Name:HOMETOWN UMATILLA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-669-1166
Mailing Address - Street 1:901 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-8655
Mailing Address - Country:US
Mailing Address - Phone:352-669-1166
Mailing Address - Fax:354-669-8866
Practice Address - Street 1:901 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-8655
Practice Address - Country:US
Practice Address - Phone:352-669-1166
Practice Address - Fax:354-669-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH221413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2007030OtherPK
5756700001Medicare NSC