Healthcare Provider Details

I. General information

NPI: 1750306619
Provider Name (Legal Business Name): TOWN AND COUNTRY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 G ST
GENEVA NE
68361-2007
US

IV. Provider business mailing address

1014 G ST
GENEVA NE
68361-2007
US

V. Phone/Fax

Practice location:
  • Phone: 402-759-4433
  • Fax: 402-759-4417
Mailing address:
  • Phone: 402-759-4433
  • Fax: 402-759-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1574
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number1574
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1574
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1574
License Number StateNE

VIII. Authorized Official

Name: ROBERT J NUNNS
Title or Position: PRESIDENT
Credential:
Phone: 402-759-4433