Organization Active NPI

Hometown Pharmacy LLC

Doing business as Glenwood South Pharmacy And Market

  • Pharmacy
  • Raleigh, NC
National Provider Identifier
1235933060
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
HOMETOWN PHARMACY LLC
Doing business as
Glenwood South Pharmacy And Market
Practice address
401 Glenwood Ave Ste 101
Raleigh, NC 27603-1219
Phone
(919) 856-9502
Fax
(919) 615-0949
NPI assigned
Apr 2, 2025
Last updated
Apr 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
CHI Trung Vu Huynh
Title
General Manager
Phone
(919) 856-9502

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

401 Glenwood Ave Ste 101
Raleigh, NC 27603-1219

Mailing address

401 Glenwood Ave Ste 101
Raleigh, NC 27603-1219
Phone (919) 856-9502

Other names 1

  • Glenwood South Pharmacy And Market Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240731000341 NC Part B Supplier - Mass Immunization (Roster Biller Only) 2860939584 1 other NPI on this enrollment
Practice locations: Raleigh, NC

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

401 Glenwood Ave
#101
Raleigh, NC 27603
Phone (610) 413-6869

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743552000000",
    "number": "1235933060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 GLENWOOD AVE STE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276031219",
            "telephone_number": "919-856-9502",
            "fax_number": "919-615-0949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 GLENWOOD AVE STE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276031219",
            "telephone_number": "919-856-9502",
            "fax_number": "919-615-0949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMETOWN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-02",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A",
        "authorized_official_last_name": "HUYNH",
        "authorized_official_first_name": "CHI TRUNG",
        "authorized_official_middle_name": "VU",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "919-856-9502"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenwood South Pharmacy And Market",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.