Country Market Pharmacies LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301007904 Issued in MI

Legal business name

COUNTRY MARKET PHARMACIES LLC

Doing business as

Country Market Pharmacy 66

Practice address

11301 Brooklyn Rd
Brooklyn, MI 49230-8485

Phone

(517) 592-2475

Fax

(517) 592-2558

NPI assigned

Sep 12, 2006

Last updated

Dec 11, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Guy Kennedy

Title

Managing Member

Phone

(517) 787-6081

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Country Market Pharmacy 66 Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Country Market Pharmacies LLC

  dba Country Market Pharmacy 12

  • Community/Retail Pharmacy
  • Chelsea, MI
  • NPI 1528162583

  1951496355

  Same PAC ID
• Country Market Pharmacies, L.L.C.

  • Community/Retail Pharmacy
  • Jackson, MI
  • NPI 1215053061

  1951496355

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan Baxter

  • Student in an Organized Health Care Education/Training Program
  • Brooklyn, MI
  • NPI 1760109912
  NPD (past)
• Kaitlyn Kono, PHARMD

  • Pharmacist
  • Brooklyn, MI
  • NPI 1649869173
  NPD (past)
• Melynda Jane Munden, PHARM.D.

  • Pharmacist
  • Brooklyn, MI
  • NPI 1649688060
  NPD (past)
• Jean Osborn, RPH

  • Ambulatory Care Pharmacist
  • Brooklyn, MI
  • NPI 1871180646
  NPD (past)
• Brandy Lynn Wiley

  • Pharmacy Technician
  • Brooklyn, MI
  • NPI 1013506641
  NPD (past)

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1346344306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 SPRING ARBOR RD.",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49203",
            "telephone_number": "517-787-6081",
            "fax_number": "517-787-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 BROOKLYN RD",
            "city": "BROOKLYN",
            "state": "MI",
            "postal_code": "492308485",
            "telephone_number": "517-592-2475",
            "fax_number": "517-592-2558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY MARKET PHARMACIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "GUY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "517-787-6081"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301007904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346344306",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2046767",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Market Pharmacy 66",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Raymond E. Cole, D.O.
• Lindsey Marie Conner, PHARMD
• Angelique M Cook
• Bode Corbin
• Sabrina R Corbin, LLP
• Darla Cover
• Leon Cross
• Hassan Ali Darsham
• Christin Renee Dowd, M.A., CCC-SLP
• Annette Dupuie

• Community/Retail Pharmacy in Brooklyn, MI
• Providers in Brooklyn, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.