Organization
COUNTRY SQUIRE DISCOUNT PHARMACY, INC
Active
Other names
COUNTRY SQUIRE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JUDSON AFMAN (PRESIDENT)
(231) 924-2120
Entity
Organization
Contact information
Practice address
30 E MAIN ST, FREMONT, MI 49412-1244
(231) 924-2120
(231) 924-6310
Mailing address
30 E MAIN ST, FREMONT, MI 49412-1244
(231) 924-2120
(231) 924-6310
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301001172
MI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1878530
—
MI
01
—
2039663
PK
—
Enumeration date
08/14/2006
Last updated
07/28/2014
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