Provider Demographics
NPI:1831491869
Name:COUNTY PHARMACY 2 LLC
Entity Type:Organization
Organization Name:COUNTY PHARMACY 2 LLC
Other - Org Name:COUNTY PHARMACY 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-378-1938
Mailing Address - Street 1:233 W CARLETON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-5033
Mailing Address - Country:US
Mailing Address - Phone:517-610-5665
Mailing Address - Fax:517-610-5730
Practice Address - Street 1:233 W CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5033
Practice Address - Country:US
Practice Address - Phone:517-610-5665
Practice Address - Fax:517-610-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301009455333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1528670791Medicaid
2127674OtherPK