Organization
COUNTRY PHARMACY INC
Active
Other names
COUNTRY PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE GUERKE (OWNER)
(980) 322-5762
Entity
Organization
Contact information
Practice address
610 W MAIN ST STE A, ROCKWELL, NC 28138-9415
(704) 209-3313
(704) 209-3316
Mailing address
8914 MAGNOLIA ESTATES DR, CORNELIUS, NC 28031-7848
(980) 322-5762
(704) 209-3316
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
12756
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568827020
—
NC
01
—
2159364
PK
—
Enumeration date
12/28/2015
Last updated
11/10/2016
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