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NPI Code Detail

MEDICARE: ALIVATION PHARMACY LLC

MEDICARE: ALIVATION PHARMACY LLC
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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacy684NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12166776OTHERPK

General Provider Information

NPI Number : 1609310192
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALIVATION PHARMACY LLC
Provider Business Mailing Address
First Line : 8550 CUTHILLS CIR
Second Line :
City : LINCOLN
State : NE
Zip : 68526-9474
Country : US
Telephone Number : 402-476-5686
Fax Number : 402-484-0524
Provider Business Practice Location Address
First Line : 8550 CUTHILLS CIR
Second Line :
City : LINCOLN
State : NE
Zip : 68526-9474
Country : US
Telephone Number : 402-476-5686
Fax Number : 402-484-0524
Authorized Official
Title or Position : OWNER
Name : WALTER DUFFY
Credential :
Telephone Number : 402-476-5686
Provider Enumeration Date : 12/19/2016
Last Update Date : 01/20/2017

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Directions to “ALIVATION PHARMACY LLC ” Practice Location

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