MEDICARE: HOMETOWN PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134282429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 220
Second Line	:	206 WEST 2ND STREET
City	:	DIXON
State	:	MO
Zip	:	65459-0220
Country	:	US
Telephone Number	:	573-759-2230
Fax Number	:	573-759-3131

Provider Business Practice Location Address
First Line	:	206 WEST 2ND STREET
Second Line	:
City	:	DIXON
State	:	MO
Zip	:	65459-0220
Country	:	US
Telephone Number	:	573-759-2230
Fax Number	:	573-759-3131

Authorized Official
Title or Position	:	RPH
Name	:	SKYE POWERS
Credential	:
Telephone Number	:	573-759-2230

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	06/05/2025

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Directions to “HOMETOWN PHARMACY ” Practice Location

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