Healthcare Provider Details

I. General information

NPI: 1740297472
Provider Name (Legal Business Name): HOMETOWN UMATILLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CENTRAL AVE
UMATILLA FL
32784-8655
US

IV. Provider business mailing address

901 N CENTRAL AVE
UMATILLA FL
32784-8655
US

V. Phone/Fax

Practice location:
  • Phone: 352-669-1166
  • Fax: 354-669-8866
Mailing address:
  • Phone: 352-669-1166
  • Fax: 354-669-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22141
License Number StateFL

VIII. Authorized Official

Name: RICHARD GREER
Title or Position: OWNER
Credential: RPH
Phone: 352-669-1166