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General NPI Number Information
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NPI Number | 1528162583
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Entity Type | Organization
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Legal Business Name | COUNTRY MARKET PHARMACIES LLC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1255 S MAIN ST
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City | CHELSEA
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State | MI
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Zip | 48118-1418
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Country | US
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Telephone | 734-433-0129
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Fax | 734-433-0147
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Provider Business Mailing Address
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Address Line | 1821 SPRING ARBOR RD
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City | JACKSON
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State | MI
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Zip | 49203-2703
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Country | US
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Telephone | 517-787-6081
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Fax | 517-787-0160
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | GUY KENNEDY
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Credential |
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Telephone | 517-787-6081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008186
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License Number State | MI
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