Healthcare Provider Details

I. General information

NPI: 1134282429
Provider Name (Legal Business Name): HOMETOWN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WEST 2ND STREET
DIXON MO
65459-0220
US

IV. Provider business mailing address

PO BOX 220 206 WEST 2ND STREET
DIXON MO
65459-0220
US

V. Phone/Fax

Practice location:
  • Phone: 573-759-2230
  • Fax: 573-759-3131
Mailing address:
  • Phone: 573-759-2230
  • Fax: 573-759-3131

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 Number
License Number State

VIII. Authorized Official

Name: SKYE POWERS
Title or Position: RPH
Credential:
Phone: 573-759-2230