Healthcare Provider Details

I. General information

NPI: 1063500684
Provider Name (Legal Business Name): CS BOSCHE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 10TH ST
GERING NE
69341-2817
US

IV. Provider business mailing address

1400 10TH ST
GERING NE
69341-2817
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-2181
  • Fax: 308-436-2765
Mailing address:
  • Phone: 308-436-2181
  • Fax: 308-436-2765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2812
License Number StateNE

VIII. Authorized Official

Name: CHRIS J BOSCHE
Title or Position: PRESIDENT
Credential: RP
Phone: 308-436-2181