Provider Demographics
NPI:1215053061
Name:COUNTRY MARKET PHARMACIES, L.L.C.
Entity type:Organization
Organization Name:COUNTRY MARKET PHARMACIES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARGOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-787-6081
Mailing Address - Street 1:1821 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2703
Mailing Address - Country:US
Mailing Address - Phone:517-787-6081
Mailing Address - Fax:517-787-0160
Practice Address - Street 1:1821 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203
Practice Address - Country:US
Practice Address - Phone:517-787-6081
Practice Address - Fax:517-787-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P48130Medicare PIN
0P48120Medicare PIN