Provider Demographics
NPI:1841302841
Name:HOMETOWN DRUG INC
Entity type:Organization
Organization Name:HOMETOWN DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DATWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-838-0909
Mailing Address - Street 1:36A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1724
Mailing Address - Country:US
Mailing Address - Phone:973-838-0909
Mailing Address - Fax:973-838-8313
Practice Address - Street 1:36A MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07403-1724
Practice Address - Country:US
Practice Address - Phone:973-838-0909
Practice Address - Fax:973-838-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 332B00000X
NJ28RS006741003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3120944OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ0155519Medicaid
NJ0154113Medicaid
5999580001Medicare NSC