Healthcare Provider Details

I. General information

NPI: 1063726396
Provider Name (Legal Business Name): SERVICE DRUG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E 6TH ST
ALLIANCE NE
69301-3412
US

IV. Provider business mailing address

302 MAIN ST
CHADRON NE
69337-2395
US

V. Phone/Fax

Practice location:
  • Phone: 308-762-2877
  • Fax: 308-762-2877
Mailing address:
  • Phone: 308-432-2400
  • Fax: 308-432-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DREW PETERSEN
Title or Position: MANAGER
Credential:
Phone: 308-432-2400