MEDICARE: HOMETOWN PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	5301006029	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811904345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN PHARMACY INC

Provider Business Mailing Address
First Line	:	4171 S OCEANA DR
Second Line	:
City	:	NEW ERA
State	:	MI
Zip	:	49446-9781
Country	:	US
Telephone Number	:	231-861-6900
Fax Number	:	231-861-7177

Provider Business Practice Location Address
First Line	:	93 W FOURTH ST STE A
Second Line	:
City	:	SUTTONS BAY
State	:	MI
Zip	:	49682-8408
Country	:	US
Telephone Number	:	231-271-6111
Fax Number	:	231-271-0984

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	REBEKAH LYN DESARMO
Credential	:	PHARM D., MBA
Telephone Number	:	231-861-6902

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	03/19/2025

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