Organization
COUNTRY SQUIRE DISCOUNT PHCY INC
Active
Other names
COUNTRY SQUIRE LTC PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
JUDSON AFMAN RPH (MEMBER)
(231) 924-2120
Entity
Organization
Contact information
Practice address
26 E MAIN ST, STE B, FREMONT, MI 49412-1244
(231) 924-2120
(231) 924-6310
Mailing address
26 E MAIN ST, STE B, FREMONT, MI 49412-1244
(231) 924-2120
(231) 924-6310
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
53010008387
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2368264
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/23/2006
Last updated
09/15/2010
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