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General NPI Number Information
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NPI Number | 1548568769
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Entity Type | Organization
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Legal Business Name | YOUR HOMETOWN PHARMACY INC
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 7428 EASTPORT PKWY STE 101
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City | LA VISTA
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State | NE
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Zip | 68128-2348
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Country | US
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Telephone | 402-991-7283
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Fax | 402-991-7281
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Provider Business Mailing Address
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Address Line | 7428 EASTPORT PKWY STE 1
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City | LA VISTA
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State | NE
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Zip | 68128-2346
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Country | US
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Telephone | 402-991-7283
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Fax | 402-991-7281
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Authorized Official
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Title or Position | CEO/OWNER
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Name | KODY HALL
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Credential |
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Telephone | 402-991-7283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 2927
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 4190
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License Number State | IA
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