NPIMap

Organization Active NPI

Country Squire Discount Phcy Inc

Doing business as Country Squire LTC Phcy

  • Long Term Care Pharmacy
  • Fremont, MI
National Provider Identifier
1871548610
Registry record updated Sep 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
53010008387 Issued in MI
Legal business name
COUNTRY SQUIRE DISCOUNT PHCY INC
Doing business as
Country Squire LTC Phcy
Practice address
26 E Main St
Ste B
Fremont, MI 49412-1244
Phone
(231) 924-2120
Fax
(231) 924-6310
NPI assigned
May 23, 2006
Last updated
Sep 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2010

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

Authorized official

Name
Judson Afman, RPHNPI 1083615504
Title
Member
Phone
(231) 924-2120

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 53010008387 MI Primary

Addresses

Primary practice location

26 E Main St
Ste B
Fremont, MI 49412-1244

Mailing address

26 E Main St
Ste B
Fremont, MI 49412-1244
Phone (231) 924-2120

Other identifiers 1

IdentifierTypeStateIssuer
2368264OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • COUNTRY SQUIRE LTC PHCY Doing business as

National Provider Directory

National Provider Directory

Locations

26 E Main St
Ste B
Fremont, MI 49412
Phone (231) 924-2120

Practitioners & affiliated clinicians

Practitioners 1

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": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284508800000",
    "number": "1871548610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 E MAIN ST",
            "address_2": "STE B",
            "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": "26 E MAIN ST",
            "address_2": "STE B",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121244",
            "telephone_number": "231-924-2120",
            "fax_number": "231-924-6310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY SQUIRE DISCOUNT PHCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2010-09-15",
        "status": "A",
        "authorized_official_last_name": "AFMAN",
        "authorized_official_first_name": "JUDSON",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "231-924-2120",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MI",
            "license": "53010008387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2368264",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COUNTRY SQUIRE LTC PHCY",
            "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 Sep 15, 2010; 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.