Healthcare Provider Details

I. General information

NPI: 1093819047
Provider Name (Legal Business Name): HOMETOWN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 E CENTER ST
WARSAW IN
46580-3603
US

IV. Provider business mailing address

4171 S OCEANA DR
NEW ERA MI
49446-9781
US

V. Phone/Fax

Practice location:
  • Phone: 574-267-7194
  • Fax: 574-267-1599
Mailing address:
  • Phone: 231-861-6900
  • Fax: 231-861-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60006450A
License Number StateIN

VIII. Authorized Official

Name: REBEKAH LYN DESARMO
Title or Position: VP OF ADMINISTRATION
Credential: PHARM D., MBA
Phone: 231-861-6900