1831465863 NPI number — COUNTY PHARMACY SERVICES PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831465863 NPI number — COUNTY PHARMACY SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY PHARMACY SERVICES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ANN ARBOR PROFESSIONAL PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831465863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 W MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48197-5437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-477-9006
Provider Business Mailing Address Fax Number:
734-477-9012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 W MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-5437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-477-9006
Provider Business Practice Location Address Fax Number:
734-477-9012
Provider Enumeration Date:
03/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BERNARD
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
734-477-9006

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5301009781 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2134362 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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