Provider Demographics
NPI:1306168083
Name:PHARMACY COUNTER, LLC
Entity type:Organization
Organization Name:PHARMACY COUNTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-473-1493
Mailing Address - Street 1:2655 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3550
Mailing Address - Country:US
Mailing Address - Phone:419-473-1493
Mailing Address - Fax:419-474-7137
Practice Address - Street 1:2070 E US HIGHWAY 223 STE B
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:517-266-2568
Practice Address - Fax:517-266-1036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMEDICA PHYSICIANS GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-22
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306168083Medicaid
OH6366510007Medicare NSC