Country Manor Campus LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

COUNTRY MANOR CAMPUS LLC

Doing business as

Country Store and Pharmacy

Practice address

520, 1St. St. NE
Sartell, MN 56377-1274

Phone

(320) 255-0801

NPI assigned

Apr 18, 2008

Last updated

Jun 30, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

THE FOUNDATION FOR HEALTH CARE CONTINUUMSAs reported in NPPES

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

Authorized official

Name

Kevin Harguth

Title

C.F.O.

Phone

(320) 258-8983

Specialties & licenses 2

Addresses

Other names 1

• Country Store and Pharmacy Doing business as

Part of

The Foundation for Health Care Continuums

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625011200000",
    "number": "1871767939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520, 1ST. ST. NE",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563771274",
            "telephone_number": "320-255-0801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520, 1ST. ST. NE",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563771274",
            "telephone_number": "320-255-0801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY MANOR CAMPUS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE FOUNDATION FOR HEALTH CARE CONTINUUMS",
        "enumeration_date": "2008-04-18",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "HARGUTH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "C.F.O.",
        "authorized_official_telephone_number": "320-258-8983"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Store and Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Country Store and Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kevin Hugh Costley, DDS
• Country Manor Campus LLC (Country Manor Extended Services)
• Country Manor Campus LLC (Champion Rehab)
• Country Manor Campus LLC (Country Manor LTC Pharmacy)
• Country Manor Campus LLC
• Country Manor Campus LLC (Country Manor Apartments)
• Country Manor Campus LLC (The Country Villa)
• Country Manor Campus LLC (Country Manor Health and Rehab Center)
• Danyel Kateland Cox-Tysk
• Abigail Coyle

• Community/Retail Pharmacy in Sartell, MN
• Providers in Sartell, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; 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.