Healthcare Provider Details

I. General information

NPI: 1346344306
Provider Name (Legal Business Name): COUNTRY MARKET PHARMACIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 BROOKLYN RD
BROOKLYN MI
49230-8485
US

IV. Provider business mailing address

1821 SPRING ARBOR RD.
JACKSON MI
49203
US

V. Phone/Fax

Practice location:
  • Phone: 517-592-2475
  • Fax: 517-592-2558
Mailing address:
  • Phone: 517-787-6081
  • Fax: 517-787-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007904
License Number StateMI

VIII. Authorized Official

Name: GUY KENNEDY
Title or Position: MANAGING MEMBER
Credential:
Phone: 517-787-6081