# WATERLOO HOMETOWN PHARMACY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1831693134
- **Authorized official:** DIANE DEANS (CONTRACTING)
- **Authorized official phone:** (920) 992-6800

## Contact information

- **Practice address:** 806 N MONROE ST, WATERLOO, WI 53594-1135
- **Practice address phone:** (920) 478-8273
- **Practice address fax:** (920) 478-8274
- **Mailing address:** 333 LOWVILLE RD, RIO, WI 53960-9437
- **Mailing address phone:** (920) 992-6800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9505 | WI | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 03/21/2018
- **Last updated:** 05/04/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2177494 | PK | — |