=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720120173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMETOWN PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 03/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2228 ALBERT PIKE RD STE B
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-4089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-760-5667
-----------------------------------------------------
Fax | 501-760-5744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2228 ALBERT PIKE RD STE B
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-4089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-760-5667
-----------------------------------------------------
Fax | 501-760-5744
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC/PRESIDENT
-----------------------------------------------------
Name | DAVID LECHAK
-----------------------------------------------------
Credential | PD
-----------------------------------------------------
Telephone | 501-760-5667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------