| NPI | 1013023787 |
|---|---|
| Doing Business As | COUNTRY MANOR LTC PHARMACY |
| Entity Type | Organization |
| Authorized Contact | BRIAN KELM CEO 320-258-8985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: MN 262882) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2010-03-26 |