# HOMETOWN PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LTC Dynamics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700172087
- **Authorized official:** VANCE OGLESBEE (PRESIDENT)
- **Authorized official phone:** (903) 389-2541

## Contact information

- **Practice address:** 2800 W HIGHWAY 22 STE A, CORSICANA, TX 75110-2454
- **Practice address phone:** (903) 872-3784
- **Practice address fax:** (903) 872-3791
- **Mailing address:** PO BOX 717, FAIRFIELD, TX 75840-0013
- **Mailing address phone:** (903) 389-2541
- **Mailing address fax:** (903) 389-8939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 27530 | TX | Yes |

## Other

- **Enumeration date:** 06/24/2011
- **Last updated:** 01/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5903427 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |