=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942455779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMETOWN PHARMACY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2008
-----------------------------------------------------
Last Update Date | 07/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 519 W TOWN PLZ
-----------------------------------------------------
City | BESSEMER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35020-5347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-426-1922
-----------------------------------------------------
Fax | 205-426-1927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 519 W TOWN PLZ
-----------------------------------------------------
City | BESSEMER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35020-5347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-426-1922
-----------------------------------------------------
Fax | 205-426-1927
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PIC, AO
-----------------------------------------------------
Name | TIMOTHY MULLINS
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 205-426-1922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 113218
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------