Provider Demographics
NPI:1952660391
Name:HOMETOWN DRUG INC
Entity Type:Organization
Organization Name:HOMETOWN DRUG INC
Other - Org Name:HOMETOWN DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/RPH
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FETKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-808-9227
Mailing Address - Street 1:2508 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-5026
Mailing Address - Country:US
Mailing Address - Phone:804-458-3784
Mailing Address - Fax:804-458-6450
Practice Address - Street 1:2508 GRAY ST
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-5026
Practice Address - Country:US
Practice Address - Phone:804-458-3784
Practice Address - Fax:804-458-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010044623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952660391Medicaid
2135182OtherPK