1619022365 NPI number — ALEX AND YVONNE SCHMUNK INC

Table of content: (NPI 1619022365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619022365 NPI number — ALEX AND YVONNE SCHMUNK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEX AND YVONNE SCHMUNK INC
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:
SONNYS 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:
1619022365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1058
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69336-1058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-262-0580
Provider Business Mailing Address Fax Number:
308-262-1736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69336-4051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-262-0580
Provider Business Practice Location Address Fax Number:
308-262-1736
Provider Enumeration Date:
01/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHMUNK
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
308-262-0580

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 2093 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2055131 . This is a "PK" identifier . This identifiers is of the category "OTHER".