NPIMap

Organization Active NPI

Hometown Pharmacy Inc

  • Institutional Pharmacy
  • Traverse City, MI
National Provider Identifier
1730819574
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
Legal business name
HOMETOWN PHARMACY INC
Practice address
1105 Sixth St RM 2451
Traverse City, MI 49684-2345
Phone
(231) 935-5678
Fax
(231) 935-6540
NPI assigned
Jun 14, 2022
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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Institutional Pharmacy 3336I0012X Primary

Addresses

Primary practice location

1105 Sixth St RM 2451
Traverse City, MI 49684-2345

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1730819574MedicaidMI

Other names 1

  • HomeTown Pharmacy #63 - Ambulatory Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

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…

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.

Locations

1105 Sixth St
Rm 2451
Traverse City, MI 49684
Phone (231) 935-5678

NPI Registry JSON

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

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1730819574",
    "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": "1105 SIXTH ST RM 2451",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-5678",
            "fax_number": "231-935-6540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMETOWN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-14",
        "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": "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": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730819574",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HomeTown Pharmacy #63 - Ambulatory",
            "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.