1750424420 NPI number — NO FRILLS PHARMACY LLC

Table of content: (NPI 1750424420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750424420 NPI number — NO FRILLS PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NO FRILLS PHARMACY LLC
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:
HEALTH MART 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:
1750424420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9411 CHESTNUT DR
Provider Second Line Business Mailing Address:
ATTN MIKE AKSAMIT
Provider Business Mailing Address City Name:
BENNINGTON
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68007-1713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-657-1793
Provider Business Mailing Address Fax Number:
402-939-0041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15817 C W HADAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNINGTON
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68007-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-932-5556
Provider Business Practice Location Address Fax Number:
402-932-1241
Provider Enumeration Date:
02/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AKSAMIT
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-657-1793

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  2866 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2816758 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10025141400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2816758 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".