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General NPI Number Information
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NPI Number | 1285167635
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Entity Type | Organization
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Legal Business Name | COUNTRY MARKET PHARMACY
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 1535 W MAUMEE ST
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City | ADRIAN
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State | MI
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Zip | 49221-1805
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Country | US
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Telephone | 517-265-9162
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 W MAUMEE ST
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City | ADRIAN
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State | MI
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Zip | 49221-1805
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Country | US
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Telephone | 517-265-9162
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. ROBERT GARGOL
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Credential | RPH
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Telephone | 734-944-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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