1154426328 NPI number — INTEGRATED HMO PHARMACY SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154426328 NPI number — INTEGRATED HMO PHARMACY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HMO PHARMACY SERVICES
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:
Provider Other Organization Name Type Code:
6
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:
1154426328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13660 CALIFORNIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68154-5233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-633-7928
Provider Business Mailing Address Fax Number:
800-801-2395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13660 CALIFORNIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68154-5233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-633-7928
Provider Business Practice Location Address Fax Number:
800-801-2395
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FREDRICKS
Authorized Official First Name:
AARON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF IHMO PHARMACY
Authorized Official Telephone Number:
800-663-7928

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X , with the licence number:  2773 , 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)





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