Organization
HOMETOWN PHARMACY INC
Active
Other names
Hometown Pharmacy #55 - Walker
Organization subpart
No
Provider details
NPI number
Authorized official
REBEKAH LYN DESARMO PHARM D., MBA (EXECUTIVE OPERATIONS ADMINISTRATOR)
(231) 652-7810
Entity
Organization
Contact information
Practice address
1181 WALKER AVE NW, GRAND RAPIDS, MI 49504-7404
(616) 458-9640
(616) 458-6650
Mailing address
1181 WALKER AVE NW, GRAND RAPIDS, MI 49504-7404
(616) 458-9640
(616) 458-6650
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301011126
MI
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053306845
—
MI
01
—
2168102
PK
—
Enumeration date
09/16/2005
Last updated
04/10/2020
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