Healthcare Provider Details

I. General information

NPI: 1215014311
Provider Name (Legal Business Name): HOMETOWN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 N MICHIGAN AVE
SHELBY MI
49455-1028
US

IV. Provider business mailing address

4171 S OCEANA DR
NEW ERA MI
49446-9781
US

V. Phone/Fax

Practice location:
  • Phone: 231-861-4341
  • Fax: 231-861-6609
Mailing address:
  • Phone: 231-861-6900
  • Fax: 231-861-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301005684
License Number StateMI

VIII. Authorized Official

Name: REBEKAH LYN DESARMO
Title or Position: VP OF ADMINISTRATION
Credential: PHARM D., MBA
Phone: 231-861-6902