NPIMap

Organization Active NPI

The Country Squire Discount Pharmacy, Inc

Doing business as Country Squire Pharmacy

  • Durable Medical Equipment & Medical Supplies
  • Fremont, MI
National Provider Identifier
1700887148
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
5301001172 Issued in MI
Legal business name
THE COUNTRY SQUIRE DISCOUNT PHARMACY, INC
Doing business as
Country Squire Pharmacy
Practice address
30 E Main
Fremont, MI 49412-1244
Phone
(231) 924-2120
Fax
(231) 924-6310
NPI assigned
Aug 9, 2005
Last updated
Jul 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Authorized official

Name
Mr. Judson K Afman, R. PH.NPI 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 5301001172 MI Primary

Addresses

Primary practice location

30 E Main
Fremont, MI 49412-1244

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
540F210020OtherMIBCBS OF MI DME
87411545MedicaidMI

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1700887148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E MAIN",
            "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",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121244",
            "telephone_number": "231-924-2120",
            "fax_number": "231-924-6310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE COUNTRY SQUIRE DISCOUNT PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "AFMAN",
        "authorized_official_first_name": "JUDSON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-924-2120",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R. PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5301001172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI DME",
            "identifier": "540F210020",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "87411545",
            "state": "MI"
        }
    ],
    "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 16, 2008; 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.