1982488219 NPI number — CAPWN REPRODUCTIVE HEALTH PROGRAM DELEGATED DISPENSING PERMIT

Table of content: (NPI 1982488219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982488219 NPI number — CAPWN REPRODUCTIVE HEALTH PROGRAM DELEGATED DISPENSING PERMIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPWN REPRODUCTIVE HEALTH PROGRAM DELEGATED DISPENSING PERMIT
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:
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:
1982488219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
975 CRESCENT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERING
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69341-1712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-632-2770
Provider Business Mailing Address Fax Number:
308-633-2650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
975 CRESCENT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERING
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69341-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-632-2770
Provider Business Practice Location Address Fax Number:
308-633-2650
Provider Enumeration Date:
08/18/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BUNDRICK
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
DELEGATING PHARMACIST
Authorized Official Telephone Number:
308-632-2770

Provider Taxonomy Codes

  • Taxonomy code: 261QP0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 32 . This is a "DELEGATED DISPENSING PERMIT NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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