NPIMap

Organization Active NPI

Hometown Pharmacy Inc

  • Community/Retail Pharmacy
  • Traverse City, MI
National Provider Identifier
1366430423
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
HOMETOWN PHARMACY INC
Practice address
550 Munson Ave Ste G100
Traverse City, MI 49686-3580
Phone
(231) 935-8730
Fax
(231) 935-8741
NPI assigned
Oct 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rebekah Lyn Desarmo, PHARM D., MBA
Title
VP of Finance
Phone
(231) 861-6902

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

550 Munson Ave Ste G100
Traverse City, MI 49686-3580

Mailing address

4171 S Oceana Dr
New Era, MI 49446-9781
Phone (231) 861-6900

Other identifiers 1

IdentifierTypeStateIssuer
1366430423MedicaidMI

Other names 1

  • HomeTown Pharmacy #65 - Medical Campus Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080627000613 MI Part B Supplier - Mass Immunization (Roster Biller Only) 2668544107 This NPI is an additional NPI on the enrollment
Practice locations: Shelby, MI; Muskegon, MI; New Buffalo, MI; New Era, MI; Newaygo, MI; Oxford, MI; Ravenna, MI; Reed City, MI…
O20110218000080 MI Part B Supplier - Mass Immunization (Roster Biller Only) 8921902958 1 other NPI on this enrollment
Practice locations: Traverse City, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Hometown Pharmacy Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1366430423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4171 S OCEANA DR",
            "city": "NEW ERA",
            "state": "MI",
            "postal_code": "494469781",
            "telephone_number": "231-861-6900",
            "fax_number": "231-861-7177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 MUNSON AVE STE G100",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863580",
            "telephone_number": "231-935-8730",
            "fax_number": "231-935-8741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMETOWN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A",
        "authorized_official_last_name": "DESARMO",
        "authorized_official_first_name": "REBEKAH",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "231-861-6902",
        "authorized_official_credential": "PHARM D., MBA"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366430423",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HomeTown Pharmacy #65 - Medical Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.