Healthcare Provider Details

I. General information

NPI: 1821083890
Provider Name (Legal Business Name): HOMETOWN OLD COUNTRY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 03/06/2024
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8534 RIDGE ROAD
NEW PORT RICKEY FL
34654
US

IV. Provider business mailing address

8534 RIDGE ROAD
NEW PORT RICKEY FL
34654
US

V. Phone/Fax

Practice location:
  • Phone: 727-816-9770
  • Fax: 727-817-1310
Mailing address:
  • Phone: 727-816-9770
  • Fax: 727-817-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SATVIK THAKKAR
Title or Position: MANAGEMENT MEMBER
Credential:
Phone: 727-816-9770