Home Town Drugs of Prineville Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

00430 Issued in OR

Legal business name

HOME TOWN DRUGS OF PRINEVILLE INC

Practice address

198 NE Combs Flat Rd Ste 100
Prineville, OR 97754-2563

Phone

(541) 447-4111

Fax

(541) 416-9570

NPI assigned

Mar 1, 2007

Organization subpart

No

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

Authorized official

Name

Michael Mendazona

Title

Director

Phone

(541) 325-1059

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Clinic Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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

• Sean P Phothiyane, PHARM.D

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Prineville, OR
  • NPI 1700119120
  NPD
• Susan Lynne Leversee, PHARM.D.

  • Pharmacist
  • Prineville, OR
  • NPI 1700161643
  NPD (past)

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607990400000",
    "number": "1801924006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "198 NE COMBS FLAT RD STE 100",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977542563",
            "telephone_number": "541-447-4111",
            "fax_number": "541-416-9570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "198 NE COMBS FLAT RD STE 100",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977542563",
            "telephone_number": "541-447-4111",
            "fax_number": "541-416-9570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME TOWN DRUGS OF PRINEVILLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "MENDAZONA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "541-325-1059"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "00430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "228749",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3804273",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Benjamin Hilleboe, MS
• Cassie Hoberecht, CRM-I
• Mark Hofer, CADC I
• Christian KS Holden
• Nicole Holly
• Shelley Renee Hood
• Sierra Hopper, MSN
• Karmen Horat
• Fred Simon Hosillos, BA
• Trevor Hostetler

• Community/Retail Pharmacy in Prineville, OR
• Providers in Prineville, OR by specialty
• Community/Retail Pharmacy in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.