Healthcare Provider Details

I. General information

NPI: 1114224193
Provider Name (Legal Business Name): HOMETOWN VILLAGE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CLAREMONT AVE SUITE #2
TAMAQUA PA
18252-4460
US

IV. Provider business mailing address

220 CLAREMONT AVE SUITE #2
TAMAQUA PA
18252-4460
US

V. Phone/Fax

Practice location:
  • Phone: 570-668-1900
  • Fax: 570-668-8812
Mailing address:
  • Phone: 570-668-1900
  • Fax: 570-668-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP482124
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LOUIS RUBINO
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 570-668-1900