Healthcare Provider Details

I. General information

NPI: 1760575070
Provider Name (Legal Business Name): HOMETOWN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 PLANK RD
MINEVILLE NY
12956-0337
US

IV. Provider business mailing address

PO BOX 1750
MECHANICSVILLE VA
23116-0005
US

V. Phone/Fax

Practice location:
  • Phone: 518-942-3313
  • Fax: 518-942-3035
Mailing address:
  • Phone:
  • Fax:

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 Number017277
License Number StateNY

VIII. Authorized Official

Name: ROBERT CORBO
Title or Position: PRES
Credential: RPH
Phone: 518-942-3313