Organization
HOMETOWN PHARMACY LLC
Active
Other names
LTC Dynamics
Organization subpart
No
Provider details
NPI number
Authorized official
VANCE OGLESBEE (PRESIDENT)
(903) 389-2541
Entity
Organization
Contact information
Practice address
2800 W HIGHWAY 22 STE A, CORSICANA, TX 75110-2454
(903) 872-3784
(903) 872-3791
Mailing address
PO BOX 717, FAIRFIELD, TX 75840-0013
(903) 389-2541
(903) 389-8939
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
27530
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5903427
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/24/2011
Last updated
01/10/2012
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