Provider Demographics
NPI:1093422966
Name:HOMETOWN PHARMACY INC
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY INC
Other - Org Name:MARTZ & SHAPLEY LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:DESARMO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, MBA
Authorized Official - Phone:231-861-6902
Mailing Address - Street 1:4171 S OCEANA DR
Mailing Address - Street 2:
Mailing Address - City:NEW ERA
Mailing Address - State:MI
Mailing Address - Zip Code:49446-9781
Mailing Address - Country:US
Mailing Address - Phone:231-861-6900
Mailing Address - Fax:231-452-6472
Practice Address - Street 1:101 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1803
Practice Address - Country:US
Practice Address - Phone:231-796-7621
Practice Address - Fax:231-796-1050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMETOWN PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-01
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy