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General NPI Number Information
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NPI Number | 1356981922
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Entity Type | Organization
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Legal Business Name | HOME TOWN PHARMACY INC
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4252 KALAMAZOO AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-3607
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Country | US
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Telephone | 616-281-1323
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Fax | 616-281-1330
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Provider Business Mailing Address
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Address Line | PO BOX 884
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City | NEWAYGO
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State | MI
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Zip | 49337-0884
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Country | US
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Telephone | 231-652-7810
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Fax | 231-652-7876
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Authorized Official
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Title or Position | EXECUTIVE OPERATIONS ADMINISTRATOR
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Name | REBEKAH LYN DESARMO
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Credential | PHARM D., MBA
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Telephone | 231-652-7810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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