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General NPI Number Information
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NPI Number | 1679537286
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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 | 04/12/2006
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 212 S STATE ST
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City | GOBLES
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State | MI
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Zip | 49055-9410
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Country | US
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Telephone | 269-628-2650
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Fax | 269-628-4022
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Provider Business Mailing Address
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Address Line | PO BOX 403
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City | GOBLES
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State | MI
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Zip | 49055-0403
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Country | US
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Telephone | 269-628-2650
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Fax | 269-628-4022
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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 |
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301006436
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License Number State | MI
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