Organization
HOMETOWN PHARMACY INC
Active
Other names
HomeTown Pharmacy #33
Organization subpart
No
Provider details
NPI number
Authorized official
REBEKAH LYN DESARMO (EXECUTIVE OPERATIONS ADMINISTRATOR)
(231) 652-7810
Entity
Organization
Contact information
Practice address
12441 STAFFORD RD, RAVENNA, MI 49451-9783
(231) 853-2261
(231) 853-6623
Mailing address
12441 STAFFORD RD, RAVENNA, MI 49451-9783
(231) 853-2261
(231) 853-6623
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009287
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2124358
PK
—
Enumeration date
09/20/2005
Last updated
04/14/2020
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