{"npi":"1326608142","type":"NPI-2","status":"active","name":{"display":"Kewaunee Hometown Pharmacy LLC","other":[],"organization_name":"KEWAUNEE HOMETOWN PHARMACY LLC","authorised_official":"Nicole Hermansen"},"specialty":{"primary_taxonomy":"3336C0003X","primary_taxonomy_description":"Community/Retail Pharmacy","slug":"community-retail-pharmacy","schema_org_specialty":null,"all":[{"code":"332B00000X","description":"Durable Medical Equipment & Medical Supplies","primary":false,"state":null,"license":null},{"code":"3336S0011X","description":"Specialty Pharmacy","primary":false,"state":null,"license":null},{"code":"3336C0003X","description":"Community/Retail Pharmacy","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"1614 CENTER ST","city":"KEWAUNEE","state":"WI","postal_code":"542161792","country_code":"US","phone":"9203101616","fax":"9203886164"},{"purpose":"MAILING","street_1":"333 LOWVILLE RD","city":"RIO","state":"WI","postal_code":"539609437","country_code":"US","phone":"9209926800","fax":"9209926801"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"100090741","state":"WI","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20190910001705","type_code":"12-A5","type_desc":"PART B SUPPLIER - PHARMACY","state":"WI","pac_id":"3476882820"},{"enrlmt_id":"O20191014000817","type_code":"30-A5","type_desc":"DME SUPPLIER - PHARMACY","state":"WI","pac_id":"3476882820"}]},"enumeration_date":"2019-06-14","last_updated":"2025-07-25","_meta":{"source":"NPPES","snapshot_date":"2025-07-25","doc_url":"https://findmynpi.com/api"}}