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General NPI Number Information
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NPI Number | 1093819047
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Entity Type | Organization
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Legal Business Name | HOMETOWN PHARMACY INC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 1775 E CENTER ST
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City | WARSAW
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State | IN
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Zip | 46580-3603
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Country | US
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Telephone | 574-267-7194
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Fax | 574-267-1599
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Provider Business Mailing Address
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Address Line | 4171 S OCEANA DR
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City | NEW ERA
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State | MI
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Zip | 49446-9781
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Country | US
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Telephone | 231-861-6900
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Fax | 231-861-7177
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Authorized Official
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Title or Position | VP OF ADMINISTRATION
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Name | REBEKAH LYN DESARMO
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Credential | PHARM D., MBA
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Telephone | 231-861-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 60006450A
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License Number State | IN
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