Organization
COUNTRYSIDE DRUG COMPANY III
Active
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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