# HOMETOWN PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HomeTown Pharmacy \#63 - Ambulatory
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730819574
- **Authorized official:** REBEKAH LYN DESARMO PHARM D., MBA (VP OF FINANCE)
- **Authorized official phone:** (231) 861-6902

## Contact information

- **Practice address:** 1105 SIXTH ST RM 2451, TRAVERSE CITY, MI 49684-2345
- **Practice address phone:** (231) 935-5678
- **Practice address fax:** (231) 935-6540
- **Mailing address:** 4171 S OCEANA DR, NEW ERA, MI 49446-9781
- **Mailing address phone:** (231) 861-6900
- **Mailing address fax:** (231) 861-7177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336I0012X | Institutional Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/14/2022
- **Last updated:** 03/19/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1730819574 | — | MI |