MEDICARE: HOME TOWN 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	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5301010897	OTHER	MI	BOARD OF PHARMACY
2	5315074625	OTHER	MI	CONTROLLED SUBSTANCE

General Provider Information

NPI Number	:	1356981922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME TOWN PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 884
Second Line	:
City	:	NEWAYGO
State	:	MI
Zip	:	49337-0884
Country	:	US
Telephone Number	:	231-652-7810
Fax Number	:	231-652-7876

Provider Business Practice Location Address
First Line	:	4252 KALAMAZOO AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-3607
Country	:	US
Telephone Number	:	616-281-1323
Fax Number	:	616-281-1330

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

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	03/07/2023

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Directions to “HOME TOWN PHARMACY INC ” Practice Location

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