Provider Demographics
NPI:1487491775
Name:HERNANDO'S HOMETOWN PHARMACY LLC
Entity type:Organization
Organization Name:HERNANDO'S HOMETOWN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-691-3784
Mailing Address - Street 1:741 E LANDIS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8016
Mailing Address - Country:US
Mailing Address - Phone:856-691-3784
Mailing Address - Fax:
Practice Address - Street 1:741 E LANDIS AVE STE B
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8016
Practice Address - Country:US
Practice Address - Phone:856-691-3784
Practice Address - Fax:856-691-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy