Provider Demographics
NPI:1285728097
Name:HOME TOWN DRUG STORES INC
Entity type:Organization
Organization Name:HOME TOWN DRUG STORES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-246-9990
Mailing Address - Street 1:423 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-9757
Mailing Address - Country:US
Mailing Address - Phone:336-246-9990
Mailing Address - Fax:336-246-6069
Practice Address - Street 1:423 E 2ND ST
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-9757
Practice Address - Country:US
Practice Address - Phone:336-246-9990
Practice Address - Fax:336-246-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11379333600000X, 3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137653OtherPK
NC00552326Medicaid