Organization
HOMETOWN APOTHECARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE SMITH (PHARMACIST)
(270) 639-5242
Entity
Organization
Contact information
Practice address
1355 US HWY 41A S, DIXON, KY 42409
(270) 639-5242
(270) 639-6369
Mailing address
PO BOX 289, DIXON, KY 42409-0289
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
PO6351
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1824994
OTHER ID NUMBER
—
05
—
54001086
—
KY
Enumeration date
04/19/2007
Last updated
09/13/2007
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