Provider Demographics
NPI:1932980513
Name:HOMETOWN MARKET , INC
Entity Type:Organization
Organization Name:HOMETOWN MARKET , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JARVENE
Authorized Official - Last Name:SHACKELFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-591-5234
Mailing Address - Street 1:7122 WILL ROBBINS HWY
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-5918
Mailing Address - Country:US
Mailing Address - Phone:662-591-5234
Mailing Address - Fax:
Practice Address - Street 1:1906 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6543
Practice Address - Country:US
Practice Address - Phone:662-591-5254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME TOWN MARKET INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy