Organization
COUNTRY MANOR CAMPUS LLC
Active
Other names
Country Manor LTC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA LEMM (PHARMACIST IN CHARGE)
(320) 255-0801
Entity
Organization
Contact information
Practice address
520 1ST ST NE, SUITE A, SARTELL, MN 56377-1274
(320) 255-0801
(320) 230-3825
Mailing address
520 1ST ST NE, SUITE A, SARTELL, MN 56377-1274
(320) 255-0801
(320) 230-3825
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
262882
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125115
PK
—
Enumeration date
04/18/2008
Last updated
06/30/2021
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