Provider Demographics
NPI:1346304904
Name:COUNTRY DRUGS
Entity Type:Organization
Organization Name:COUNTRY DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-684-8251
Mailing Address - Street 1:362 STATE PARK DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-1340
Mailing Address - Country:US
Mailing Address - Phone:989-684-8251
Mailing Address - Fax:989-684-1505
Practice Address - Street 1:362 STATE PARK DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-1340
Practice Address - Country:US
Practice Address - Phone:989-684-8251
Practice Address - Fax:989-684-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2337322Medicaid