Healthcare Provider Details

I. General information

NPI: 1891894754
Provider Name (Legal Business Name): HOMETOWN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/19/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 OLD COURTHOUSE RD
APPOMATTOX VA
24522-9853
US

IV. Provider business mailing address

199 OLD COURTHOUSE RD
APPOMATTOX VA
24522-9853
US

V. Phone/Fax

Practice location:
  • Phone: 434-352-3784
  • Fax: 434-352-3717
Mailing address:
  • Phone: 434-352-3784
  • 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 Number0201003970
License Number StateVA

VIII. Authorized Official

Name: LISA SMITH
Title or Position: OWNER
Credential:
Phone: 434-352-3784