Kewaunee Hometown Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

KEWAUNEE HOMETOWN PHARMACY LLC

Doing business as

KEWAUNEE HOMETOWN PHARMACY

Practice address

1614 Center St
Kewaunee, WI 54216-1792

Phone

(920) 310-1616

Fax

(920) 388-6164

NPI assigned

Jun 14, 2019

Organization subpart

No

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

Authorized official

Name

Nicole Hermansen

Title

Contracting Specialist

Phone

(920) 992-6800

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• KEWAUNEE HOMETOWN PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lanea Ebel, PHARMD

  • Pharmacist
  • Fort Wayne, IN
  • NPI 1003594615
  NPD (past)

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

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753401600000",
    "number": "1326608142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 LOWVILLE RD",
            "city": "RIO",
            "state": "WI",
            "postal_code": "539609437",
            "telephone_number": "920-992-6800",
            "fax_number": "920-992-6801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 CENTER ST",
            "city": "KEWAUNEE",
            "state": "WI",
            "postal_code": "542161792",
            "telephone_number": "920-310-1616",
            "fax_number": "920-388-6164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEWAUNEE HOMETOWN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-14",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A",
        "authorized_official_last_name": "HERMANSEN",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CONTRACTING SPECIALIST",
        "authorized_official_telephone_number": "920-992-6800"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100090741",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KEWAUNEE HOMETOWN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KEWAUNEE HOMETOWN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tricia Lynn Keister, R.N.
• Kenneth J & Marilyn M Secor
• Kenneth J & Marilyn M Secor
• Kewaunee Care Center LLC
• Kewaunee Chiropractic Works LLC
• Kewaunee School District
• Kelly J Kovnesky, LPC-IT
• Jacob Kumpfer, LMFT-IT
• Lakeshore Vision Centers LTD
• Robin Lambrecht, LPC

• Community/Retail Pharmacy in Kewaunee, WI
• Providers in Kewaunee, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.