Provider Demographics
NPI:1962715565
Name:OUR HOME PHARMACY INC
Entity type:Organization
Organization Name:OUR HOME PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-887-8780
Mailing Address - Street 1:2320 MOORES MILL RD STE 100
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-8403
Mailing Address - Country:US
Mailing Address - Phone:334-887-8780
Mailing Address - Fax:334-887-8786
Practice Address - Street 1:2154 MOORES MILL RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8447
Practice Address - Country:US
Practice Address - Phone:334-887-8780
Practice Address - Fax:334-887-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
AL1133953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126111OtherPK
AL1231350Medicaid