Provider Demographics
NPI:1467407916
Name:HOMETOWN PHARMACY INC.
Entity Type:Organization
Organization Name:HOMETOWN PHARMACY INC.
Other - Org Name:HOMETOWN PHARMACY #43 - SUTTONS BAY
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 DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW ERA
Mailing Address - State:MI
Mailing Address - Zip Code:49446
Mailing Address - Country:US
Mailing Address - Phone:231-861-6900
Mailing Address - Fax:231-861-7177
Practice Address - Street 1:321B N SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-5104
Practice Address - Country:US
Practice Address - Phone:231-271-3881
Practice Address - Fax:231-271-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MI53010102213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1467407916Medicaid
2142384OtherPK
MI2834692Medicaid