MEDICARE: SYRACUSE TOWN & COUNTRY PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	1480	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2053558	OTHER		PK

General Provider Information

NPI Number	:	1285695478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYRACUSE TOWN & COUNTRY PHARMACY

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

Provider Business Practice Location Address
First Line	:	1710 POPLAR STREET
Second Line	:
City	:	SYRACUSE
State	:	NE
Zip	:	68446-9302
Country	:	US
Telephone Number	:	402-269-2001
Fax Number	:	402-269-2828

Authorized Official
Title or Position	:	PHARM MANG/PIC
Name	:	RONDA STINSON
Credential	:	RP
Telephone Number	:	402-269-2001

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	02/25/2020

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Directions to “SYRACUSE TOWN & COUNTRY PHARMACY ” Practice Location

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