Healthcare Provider Details

I. General information

NPI: 1730819574
Provider Name (Legal Business Name): HOMETOWN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SIXTH ST RM 2451
TRAVERSE CITY MI
49684-2345
US

IV. Provider business mailing address

4171 S OCEANA DR
NEW ERA MI
49446-9781
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-5678
  • Fax: 231-935-6540
Mailing address:
  • Phone: 231-861-6900
  • Fax: 231-861-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

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