Provider Demographics
NPI:1861430811
Name:HARRISBURGS HOMETOWN PHARMACY INC
Entity type:Organization
Organization Name:HARRISBURGS HOMETOWN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-454-7948
Mailing Address - Street 1:5006 HWY 49 SOUTH
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075
Mailing Address - Country:US
Mailing Address - Phone:704-454-7948
Mailing Address - Fax:704-455-8457
Practice Address - Street 1:5006 HWY 49 SOUTH
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075
Practice Address - Country:US
Practice Address - Phone:704-454-7948
Practice Address - Fax:704-455-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2019-01-14
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-06-19
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
NC091043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0135935Medicaid
NC5534940001OtherMEDICARE
NC0135935Medicaid