1568095115 NPI number — SYRACUSE TOWN & COUNTRY PHARMACY, INC

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 1568095115 NPI number — SYRACUSE TOWN & COUNTRY PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYRACUSE TOWN & COUNTRY PHARMACY, 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:
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:
1568095115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68446-0220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-269-2001
Provider Business Mailing Address Fax Number:
402-269-2828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 POPLAR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68446-6844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-269-2001
Provider Business Practice Location Address Fax Number:
402-269-2828
Provider Enumeration Date:
02/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
STINSON
Authorized Official First Name:
RONDA
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
402-269-3847

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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