Healthcare Provider Details

I. General information

NPI: 1578148037
Provider Name (Legal Business Name): DESKINS HOMETOWN PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 06/29/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6912 RIVERSIDE DRIVE SUITE 4
RAVEN VA
24639
US

IV. Provider business mailing address

6912 RIVERSIDE DRIVE SUITE 4
RAVEN VA
24639
US

V. Phone/Fax

Practice location:
  • Phone: 276-498-4663
  • Fax:
Mailing address:
  • Phone: 276-498-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. HILARY BETH DESKINS
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 720-352-4721