Healthcare Provider Details

I. General information

NPI: 1235156704
Provider Name (Legal Business Name): SINCERERX HOMETOWN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 1ST AVENUE
KINDER LA
70648
US

IV. Provider business mailing address

715 1ST AVE
KINDER LA
70648-3511
US

V. Phone/Fax

Practice location:
  • Phone: 337-738-2614
  • Fax: 337-738-2523
Mailing address:
  • Phone: 337-738-2614
  • Fax: 337-738-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER SAAD
Title or Position: MANAGER
Credential:
Phone: 318-259-7334