Organization
THE COUNTRY SQUIRE DISCOUNT PHARMACY, INC
Active
Other names
Country Squire Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUDSON K AFMAN R. PH. (PRESIDENT)
(231) 924-2120
Entity
Organization
Contact information
Practice address
30 E MAIN, FREMONT, MI 49412-1244
(231) 924-2120
(231) 924-6310
Mailing address
30 E MAIN, FREMONT, MI 49412-1244
(231) 924-2120
(231) 924-6310
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
5301001172
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540F210020
BCBS OF MI DME
MI
05
—
87411545
—
MI
Enumeration date
08/09/2005
Last updated
07/16/2008
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