Healthcare Provider Details

I. General information

NPI: 1144304890
Provider Name (Legal Business Name): HOMETOWN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 WEST SHAW
HOWARD CITY MI
49329
US

IV. Provider business mailing address

60 E 82ND STREET PO BOX 884
NEWAYGO MI
49337
US

V. Phone/Fax

Practice location:
  • Phone: 231-937-5282
  • Fax: 231-937-7472
Mailing address:
  • Phone: 231-652-7810
  • Fax: 231-652-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301005778
License Number StateMI

VIII. Authorized Official

Name: REBEKAH LYN DESARMO
Title or Position: EXECUTIVE OPERATIONS ADMINSTRATOR
Credential: PHARM D., MBA
Phone: 231-652-7810