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General NPI Number Information
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NPI Number | 1700172087
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Entity Type | Organization
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Legal Business Name | HOMETOWN PHARMACY LLC
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 2800 W HIGHWAY 22 STE A
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City | CORSICANA
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State | TX
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Zip | 75110-2454
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Country | US
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Telephone | 903-872-3784
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Fax | 903-872-3791
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Provider Business Mailing Address
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Address Line | PO BOX 717
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City | FAIRFIELD
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State | TX
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Zip | 75840-0013
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Country | US
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Telephone | 903-389-2541
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Fax | 903-389-8939
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Authorized Official
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Title or Position | PRESIDENT
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Name | VANCE OGLESBEE
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Credential |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 27530
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License Number State | TX
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