=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932980513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMETOWN MARKET , INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2023
-----------------------------------------------------
Last Update Date | 02/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1906 S GLOSTER ST
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-6543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-591-5254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1906 S GLOSTER ST
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-6543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-260-6595
-----------------------------------------------------
Fax | 662-260-6297
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | MILLIE DYSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-260-6595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------