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General NPI Number Information
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NPI Number | 1962081190
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Entity Type | Organization
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Legal Business Name | HOMERUN GENERAL STORES
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 806 S JASPER ST
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City | DECATUR
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State | IL
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Zip | 62521-3543
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Country | US
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Telephone | 217-848-1449
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Fax |
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Provider Business Mailing Address
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Address Line | 806 S JASPER ST
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City | DECATUR
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State | IL
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Zip | 62521-3543
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACISTS/OWNER
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Name | RIBHI QATTOUM
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Credential | PHARM.D
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Telephone | 217-848-1449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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