MEDICARE: OUR HOME 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	113395	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2126111	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962715565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR HOME PHARMACY INC

Provider Business Mailing Address
First Line	:	2320 MOORES MILL RD STE 100
Second Line	:	SUITE 100
City	:	AUBURN
State	:	AL
Zip	:	36830-8403
Country	:	US
Telephone Number	:	334-887-8780
Fax Number	:	334-887-8786

Provider Business Practice Location Address
First Line	:	2154 MOORES MILL RD
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-8447
Country	:	US
Telephone Number	:	334-887-8780
Fax Number	:	334-887-8786

Authorized Official
Title or Position	:	OWNER/PRESIDENT/PIC/AO
Name	:	DONALD HYATT
Credential	:
Telephone Number	:	334-887-8780

Provider Enumeration Date	:	07/23/2010
Last Update Date	:	12/19/2022

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Directions to “OUR HOME PHARMACY INC ” Practice Location

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