1356455414 NPI number — HOMETOWN BUSINESSES INC.

Table of content: (NPI 1356455414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356455414 NPI number — HOMETOWN BUSINESSES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMETOWN BUSINESSES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOMETOWN PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356455414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
512 8TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-737-4919
Provider Business Mailing Address Fax Number:
712-737-4969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
512 8TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-737-4919
Provider Business Practice Location Address Fax Number:
712-737-4969
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KLEINHESSELINK
Authorized Official First Name:
JESSE
Authorized Official Middle Name:
I.
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
712-737-4919

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  666 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 666 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X , with the licence number: 666 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 666 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0081679 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1356455414 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 666 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1607019 . This is a "NABP#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1607019 . This is a "NCPDP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".