Healthcare Provider Details

I. General information

NPI: 1215053061
Provider Name (Legal Business Name): COUNTRY MARKET PHARMACIES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 SPRING ARBOR RD
JACKSON MI
49203
US

IV. Provider business mailing address

1821 SPRING ARBOR RD
JACKSON MI
49203-2703
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MELISSA GARGOL
Title or Position: DIRECTOR OF PHARMACY OPERATIONS
Credential:
Phone: 517-787-6081