Provider Demographics
NPI:1881780112
Name:HOMETOWN PHARMACY
Entity type:Organization
Organization Name:HOMETOWN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-686-9339
Mailing Address - Street 1:407 E MCPHERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-2274
Mailing Address - Country:US
Mailing Address - Phone:229-686-9339
Mailing Address - Fax:229-686-7888
Practice Address - Street 1:407 E MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-2274
Practice Address - Country:US
Practice Address - Phone:229-686-9339
Practice Address - Fax:229-686-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0070373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00387494AMedicaid
GA0659600001Medicare ID - Type UnspecifiedMEDICARE