# HOME TOWN DRUGS OF PRINEVILLE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clinic Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801924006
- **Authorized official:** MICHAEL MENDAZONA (DIRECTOR)
- **Authorized official phone:** (541) 325-1059

## Contact information

- **Practice address:** 198 NE COMBS FLAT RD STE 100, PRINEVILLE, OR 97754-2563
- **Practice address phone:** (541) 447-4111
- **Practice address fax:** (541) 416-9570
- **Mailing address:** 198 NE COMBS FLAT RD STE 100, PRINEVILLE, OR 97754-2563
- **Mailing address phone:** (541) 447-4111
- **Mailing address fax:** (541) 416-9570

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 00430 | OR | Yes |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 12/15/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 228749 | — | OR |
| 01 | — | 3804273 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |