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NPI Code Detail

MEDICARE: HOMETOWN PHARMACY INC

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
13336C0004XCompounding Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacy
43336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366430423
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOMETOWN PHARMACY INC
Provider Business Mailing Address
First Line : 4171 S OCEANA DR
Second Line :
City : NEW ERA
State : MI
Zip : 49446-9781
Country : US
Telephone Number : 231-861-6900
Fax Number : 231-861-7177
Provider Business Practice Location Address
First Line : 550 MUNSON AVE STE G100
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-3580
Country : US
Telephone Number : 231-935-8730
Fax Number : 231-935-8741
Authorized Official
Title or Position : VP OF FINANCE
Name : REBEKAH LYN DESARMO
Credential : PHARM D., MBA
Telephone Number : 231-861-6902
Provider Enumeration Date : 10/12/2005
Last Update Date : 03/19/2025

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Directions to “HOMETOWN PHARMACY INC ” Practice Location

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