Healthcare Provider Details

I. General information

NPI: 1285728097
Provider Name (Legal Business Name): HOME TOWN DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 2ND ST
WEST JEFFERSON NC
28694-9757
US

IV. Provider business mailing address

423 E 2ND ST
WEST JEFFERSON NC
28694-9757
US

V. Phone/Fax

Practice location:
  • Phone: 336-246-9990
  • Fax: 336-246-6069
Mailing address:
  • Phone: 336-246-9990
  • Fax: 336-246-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number11379
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11379
License Number StateNC

VIII. Authorized Official

Name: ALETHA ELLER
Title or Position: CEO
Credential: PHARMD
Phone: 336-246-9990