MEDICARE: HOMER CITY PHARMACY INC

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	PP411188L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2085289	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356352926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMER CITY PHARMACY INC

Provider Business Mailing Address
First Line	:	237 WASHINGTON ST
Second Line	:
City	:	SALTSBURG
State	:	PA
Zip	:	15681-1131
Country	:	US
Telephone Number	:	724-639-9022
Fax Number	:	724-639-3535

Provider Business Practice Location Address
First Line	:	237 WASHINGTON ST
Second Line	:
City	:	SALTSBURG
State	:	PA
Zip	:	15681-1131
Country	:	US
Telephone Number	:	724-639-9022
Fax Number	:	724-639-3535

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	DAVID MATEER
Credential	:
Telephone Number	:	724-639-9022

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	03/13/2017

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Directions to “HOMER CITY PHARMACY INC ” Practice Location

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