Organization
COUNTRYSIDE DRUG COMPANY III
Active
Other names
COUNTRYSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE DEAL RPH (MANG)
(989) 427-5141
Entity
Organization
Contact information
Practice address
503 E MAIN ST, EDMORE, MI 48829-9709
(989) 427-5141
(989) 427-5142
Mailing address
PO BOX 197, EDMORE, MI 48829-0197
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301005214
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2040614
PK
—
05
—
2606436
—
MI
Enumeration date
12/04/2006
Last updated
04/08/2016
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