Countryside Drug Company I

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301004422 Issued in MI

Legal business name

COUNTRYSIDE DRUG COMPANY I

Doing business as

Countryside Pharmacy

Practice address

217 E Main St
Stanton, MI 48888-9806

Phone

(989) 831-4140

Fax

(989) 831-5801

NPI assigned

Jun 22, 2006

Last updated

May 1, 2017By 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

Susan Stratton

Title

Coo

Phone

(989) 831-4140

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• COUNTRYSIDE PHARMACY Doing business as

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

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493596800000",
    "number": "1871539320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 727",
            "city": "STANTON",
            "state": "MI",
            "postal_code": "488880727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 E MAIN ST",
            "city": "STANTON",
            "state": "MI",
            "postal_code": "488889806",
            "telephone_number": "989-831-4140",
            "fax_number": "989-831-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE DRUG COMPANY I",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2017-05-01",
        "status": "A",
        "authorized_official_last_name": "STRATTON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "989-831-4140"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301004422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1756250",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2039498",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COUNTRYSIDE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sara A Clevenger
• Victoria Collett
• Esther M Combs, LPC
• Cypress Lynn Condon-Struble
• Lisa A Cortez, QMHP
• County of Montcalm
• John Stewart Couture, RN
• Penny Jean Crawford, LLBSW
• Michell M Curtis
• Kayla Marie Datema

• Community/Retail Pharmacy in Stanton, MI
• Providers in Stanton, 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 May 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.