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Organization
HOMERUN GENERAL STORES
Active
Organization
HOMERUN GENERAL STORES
Active
Other names
Homerun Food and Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RIBHI QATTOUM PHARM.D (PHARMACISTS/OWNER)
(217) 848-1449
Entity
Organization
Contact information
Practice address
806 S JASPER ST, DECATUR, IL 62521-3543
(217) 848-1449
Mailing address
806 S JASPER ST, DECATUR, IL 62521-3543
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275129314
PERSONAL NPI
IL
Enumeration date
04/05/2021
Last updated
08/06/2021
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