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General NPI Number Information
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NPI Number | 1376645499
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Entity Type | Organization
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Legal Business Name | HOMETOWN PHARMACY
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 201 E COMMERCE ST
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City | FAIRFIELD
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State | TX
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Zip | 75840-1509
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Country | US
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Telephone | 903-389-2541
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E COMMERCE ST
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City | FAIRFIELD
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State | TX
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Zip | 75840-1509
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Country | US
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Telephone | 903-389-2541
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Fax |
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Authorized Official
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Title or Position | CORPORATE MANAGER
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Name | MR. VANCE JACKSON OGLESBEE
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Credential | R.P.H.
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Telephone | 903-389-2541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 4519647
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License Number State | TX
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