# KEWAUNEE HOMETOWN PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KEWAUNEE HOMETOWN PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326608142
- **Authorized official:** NICOLE HERMANSEN (CONTRACTING SPECIALIST)
- **Authorized official phone:** (920) 992-6800

## Contact information

- **Practice address:** 1614 CENTER ST, KEWAUNEE, WI 54216-1792
- **Practice address phone:** (920) 310-1616
- **Practice address fax:** (920) 388-6164
- **Mailing address:** 333 LOWVILLE RD, RIO, WI 53960-9437
- **Mailing address phone:** (920) 992-6800
- **Mailing address fax:** (920) 992-6801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/14/2019
- **Last updated:** 07/25/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100090741 | — | WI |