Hometown Pharmacy
Organization Active NPI Pharmacy · Fairfield, TX
NPI 1376645499 · NPPES record last updated Apr 5, 2016
Key facts
- NPI
- 1376645499
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 4519647 (TX)
- Legal business name
- HOMETOWN PHARMACY
- Practice address
- 201 E Commerce St
Fairfield, TX 75840-1509 - Phone
- (903) 389-2541
- NPI assigned
- Sep 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Vance Jackson Oglesbee, R.P.H.
- Title
- Corporate Manager
- Phone
- (903) 389-2541
Other NPIs on the same Medicare enrollment 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140110000125 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 5890902019 |
1 other NPI on this enrollment Practice locations: Corsicana, TX; Fairfield, TX |
National Provider Directory
Locations
201 E Commerce St
Fairfield, TX 75840
Phone (903) 389-2541
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 4519647 | TX | Yes |
Addresses
Primary practice location
201 E Commerce St
Fairfield, TX 75840-1509
Mailing address
201 E Commerce St
Fairfield, TX 75840-1509
Phone (903) 389-2541
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 145177 | Medicaid | TX | |
| 4519647 | Other | TX | NABP |
| 150464901 | Medicaid | TX |
Other providers in Fairfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 5, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.