Healthcare Provider Details

I. General information

NPI: 1003771858
Provider Name (Legal Business Name): HOMETOWN PHARMACY OF SPRINGFIELD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W DEPOT ST
SPRINGFIELD KY
40069-1190
US

IV. Provider business mailing address

100 W DEPOT ST
SPRINGFIELD KY
40069-1190
US

V. Phone/Fax

Practice location:
  • Phone: 859-217-5050
  • Fax: 859-217-5051
Mailing address:
  • Phone: 859-217-5050
  • Fax: 859-217-5051

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: BENJAMIN PATRICK MUDD
Title or Position: CO-OWNER
Credential:
Phone: 502-227-2303