Healthcare Provider Details

I. General information

NPI: 1841585536
Provider Name (Legal Business Name): FSTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 G ST
CENTRAL CITY NE
68826-1755
US

IV. Provider business mailing address

401 G ST
CENTRAL CITY NE
68826-1755
US

V. Phone/Fax

Practice location:
  • Phone: 308-946-2205
  • Fax: 308-946-2207
Mailing address:
  • Phone: 308-946-2205
  • Fax: 308-946-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2905
License Number StateNE

VIII. Authorized Official

Name: FADI TANBOUZA-HUSSEINI
Title or Position: PRESIDENT/PHARMACIST
Credential:
Phone: 308-946-2205