Provider Demographics
NPI:1407416100
Name:HOMETOWN DRUGS OF SUTHERLIN, INC.
Entity type:Organization
Organization Name:HOMETOWN DRUGS OF SUTHERLIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBYSINGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-459-2712
Mailing Address - Street 1:113 E. CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479
Mailing Address - Country:US
Mailing Address - Phone:541-459-2712
Mailing Address - Fax:541-459-9129
Practice Address - Street 1:113 E CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479
Practice Address - Country:US
Practice Address - Phone:541-459-2712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMETOWN DRUGS OF SUTHERLIN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy