Waterloo Hometown Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9505 Issued in WI

Legal business name

WATERLOO HOMETOWN PHARMACY LLC

Practice address

806 N Monroe St
Waterloo, WI 53594-1135

Phone

(920) 478-8273

Fax

(920) 478-8274

NPI assigned

Mar 21, 2018

Organization subpart

No

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

Authorized official

Name

Diane Deans

Title

Contracting

Phone

(920) 992-6800

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• WATERLOO HOMETOWN PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525392000000",
    "number": "1831693134",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 N MONROE ST",
            "city": "WATERLOO",
            "state": "WI",
            "postal_code": "535941135",
            "telephone_number": "920-478-8273",
            "fax_number": "920-478-8274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERLOO HOMETOWN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-21",
        "last_updated": "2018-05-04",
        "status": "A",
        "authorized_official_last_name": "DEANS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "CONTRACTING",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9505",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2177494",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WATERLOO HOMETOWN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dalton Venden
• Waterloo Family Dental,
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• Community/Retail Pharmacy in Waterloo, WI
• Providers in Waterloo, 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 May 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.