=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427781202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY PHARMACY SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2022
-----------------------------------------------------
Last Update Date | 07/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 W MICHIGAN AVE
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-5437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-477-9006
-----------------------------------------------------
Fax | 734-477-9012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 W MICHIGAN AVE
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-5437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-477-9006
-----------------------------------------------------
Fax | 734-477-9012
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | LAURA BERNARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-477-9006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------