MEDICARE: HOMETOWN PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	5301005778	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5301005778	OTHER	MI	BOARD OF PHARMACY
2	2350534	OTHER		NCPDP NUMBER

General Provider Information

NPI Number	:	1144304890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN PHARMACY INC

Provider Business Mailing Address
First Line	:	60 E 82ND STREET
Second Line	:	PO BOX 884
City	:	NEWAYGO
State	:	MI
Zip	:	49337
Country	:	US
Telephone Number	:	231-652-7810
Fax Number	:	231-652-7876

Provider Business Practice Location Address
First Line	:	730 WEST SHAW
Second Line	:
City	:	HOWARD CITY
State	:	MI
Zip	:	49329
Country	:	US
Telephone Number	:	231-937-5282
Fax Number	:	231-937-7472

Authorized Official
Title or Position	:	EXECUTIVE OPERATIONS ADMINSTRATOR
Name	:	REBEKAH LYN DESARMO
Credential	:	PHARM D., MBA
Telephone Number	:	231-652-7810

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/10/2020

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Directions to “HOMETOWN PHARMACY INC ” Practice Location

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