Healthcare Provider Details

I. General information

NPI: 1245852185
Provider Name (Legal Business Name): SERVICE DRUGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 MAIN ST.
CRAWFORD NE
69339-1026
US

IV. Provider business mailing address

302 MAIN ST
CHADRON NE
69337-2395
US

V. Phone/Fax

Practice location:
  • Phone: 308-665-4138
  • Fax: 308-665-4139
Mailing address:
  • Phone: 308-432-2400
  • Fax: 308-432-6759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREW PETERSEN
Title or Position: OWNER
Credential:
Phone: 308-430-5400