Organization
GOFORTH PHARMACY LLC
Active
Other names
HOMETOWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT GOFORTH PHRMD (PRESIDENT)
(606) 305-1321
Entity
Organization
Contact information
Practice address
406 BOGLE ST, SOMERSET, KY 42503
(606) 677-1062
(606) 677-1182
Mailing address
406 BOGLE ST, SOMERSET, KY 42503-2840
(606) 677-1062
(606) 677-1182
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P07201
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1830288
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
7100004180
—
KY
05
—
7100025300
—
KY
Enumeration date
08/05/2007
Last updated
08/19/2009
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