NPIMap

Organization Active NPI

Country Squire Discount Pharmacy, Inc

  • Community/Retail Pharmacy
  • Fremont, MI
National Provider Identifier
1265445936
Registry record updated Jul 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301001172 Issued in MI
Legal business name
COUNTRY SQUIRE DISCOUNT PHARMACY, INC
Practice address
30 E Main St
Fremont, MI 49412-1244
Phone
(231) 924-2120
Fax
(231) 924-6310
NPI assigned
Aug 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judson AfmanNPI 1083615504
Title
President
Phone
(231) 924-2120

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 5301001172 MI Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

30 E Main St
Fremont, MI 49412-1244

Mailing address

30 E Main St
Fremont, MI 49412-1244
Phone (231) 924-2120

Other identifiers 2

IdentifierTypeStateIssuer
1878530MedicaidMI
2039663OtherPK

Other names 1

  • COUNTRY SQUIRE PHARMACY Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406505600000",
    "number": "1265445936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E MAIN ST",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121244",
            "telephone_number": "231-924-2120",
            "fax_number": "231-924-6310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E MAIN ST",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121244",
            "telephone_number": "231-924-2120",
            "fax_number": "231-924-6310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY SQUIRE DISCOUNT PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2014-07-28",
        "status": "A",
        "authorized_official_last_name": "AFMAN",
        "authorized_official_first_name": "JUDSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-924-2120"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301001172",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1878530",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2039663",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COUNTRY SQUIRE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.