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Organization
COUNTRY SQUIRE DISCOUNT PHCY INC
Active
Organization
COUNTRY SQUIRE DISCOUNT PHCY INC
Active
Other names
COUNTRY SQUIRE LTC PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
JUDSON AFMAN RPH (MEMBER)
(231) 924-2120
Entity
Organization
Contact information
Practice address
26 E MAIN ST, STE B, FREMONT, MI 49412-1244
(231) 924-2120
(231) 924-6310
Mailing address
26 E MAIN ST, STE B, FREMONT, MI 49412-1244
(231) 924-2120
(231) 924-6310
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
53010008387
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2368264
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/23/2006
Last updated
09/15/2010
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