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General NPI Number Information
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NPI Number | 1013107242
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Entity Type | Organization
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Legal Business Name | HOMETOWN PHARMACY 1 LLC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 10157 LEM TURNER RD
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City | JACKSONVILLE
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State | FL
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Zip | 32218-5044
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Country | US
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Telephone | 904-764-4256
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Fax | 904-764-6873
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Provider Business Mailing Address
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Address Line | 10157 LEM TURNER RD
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City | JACKSONVILLE
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State | FL
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Zip | 32218-5044
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Country | US
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Telephone | 904-764-4256
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Fax | 904-764-6873
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN HURLEY
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Credential |
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Telephone | 904-764-4256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH22809
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License Number State | FL
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