Healthcare Provider Details

I. General information

NPI: 1265095855
Provider Name (Legal Business Name): HOMER'S PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S MAIN ST
ARLINGTON SD
57212-2086
US

IV. Provider business mailing address

46524 213TH ST
VOLGA SD
57071-6338
US

V. Phone/Fax

Practice location:
  • Phone: 605-983-5711
  • Fax: 605-983-5711
Mailing address:
  • Phone: 605-690-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. TANYA MARIE GRUNTMEIR
Title or Position: OWNER/PHARMACIST
Credential: PHARMD
Phone: 605-983-5711