Provider Demographics
NPI:1275173841
Name:HOME TOWN PHARMACY INC
Entity Type:Organization
Organization Name:HOME TOWN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OPERATIONS ADMINISTRATOR
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:231-652-7810
Mailing Address - Street 1:PO BOX 884
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-0884
Mailing Address - Country:US
Mailing Address - Phone:231-652-7810
Mailing Address - Fax:231-652-7876
Practice Address - Street 1:606 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-6620
Practice Address - Country:US
Practice Address - Phone:574-255-2988
Practice Address - Fax:574-258-5945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME TOWN PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN60006398AOtherBOARD OF PHARMACY
IN60006398BOtherCONTROLLED SUBSTANCE
FH4849913OtherDEA