Provider Demographics
NPI:1801085212
Name:HOMETOWN DRUGS OF SWEET HOME INC
Entity type:Organization
Organization Name:HOMETOWN DRUGS OF SWEET HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CALHOON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-367-6777
Mailing Address - Street 1:621 MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-3339
Mailing Address - Country:US
Mailing Address - Phone:541-367-6777
Mailing Address - Fax:541-367-6500
Practice Address - Street 1:621 MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-3339
Practice Address - Country:US
Practice Address - Phone:541-367-6777
Practice Address - Fax:541-367-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP00024433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR243141Medicaid
3842970OtherNCPDP PROVIDER IDENTIFICATION NUMBER