Organization
COUNTRYSIDE DRUG COMPANY I
Active
Other names
COUNTRYSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN STRATTON (COO)
(989) 831-4140
Entity
Organization
Contact information
Practice address
217 E MAIN ST, STANTON, MI 48888-9806
(989) 831-4140
(989) 831-5801
Mailing address
PO BOX 727, STANTON, MI 48888-0727
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301004422
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1756250
—
MI
01
—
2039498
PK
—
Enumeration date
06/22/2006
Last updated
05/01/2017
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