# HOMETOWN LONG TERM CARE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hometown Long Term Care Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659634988
- **Authorized official:** DIANE DEANS (CONTRACTING SPECIALIST)
- **Authorized official phone:** (920) 992-6800

## Contact information

- **Practice address:** 1571 IVORY DR, SUN PRAIRIE, WI 53590-1820
- **Practice address phone:** (608) 846-2750
- **Practice address fax:** (608) 846-2751
- **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 |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 9427-42 | WI | Yes |

## Other

- **Enumeration date:** 06/21/2012
- **Last updated:** 09/19/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2137457 | PK | — |