Provider Demographics
NPI:1992104442
Name:SILVERS HOMETOWN PHARMACY LLC
Entity type:Organization
Organization Name:SILVERS HOMETOWN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-343-0101
Mailing Address - Street 1:1251 W COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-3177
Mailing Address - Country:US
Mailing Address - Phone:606-343-0101
Mailing Address - Fax:606-343-0041
Practice Address - Street 1:1251 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-3177
Practice Address - Country:US
Practice Address - Phone:606-343-0101
Practice Address - Fax:606-343-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP076453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100660260Medicaid
KYP07645OtherPHARMACY PERMIT NUMBER
KY1834565OtherNCPDP
KY7499090001Medicare NSC