Healthcare Provider Details

I. General information

NPI: 1740012855
Provider Name (Legal Business Name): USPRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 BROADWAY
IMPERIAL NE
69033-3119
US

IV. Provider business mailing address

23 N SPRUCE ST
OGALLALA NE
69153-2548
US

V. Phone/Fax

Practice location:
  • Phone: 308-882-4949
  • Fax: 308-882-3903
Mailing address:
  • Phone: 308-284-2242
  • Fax:

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: BRIAN SCOTT WILSON
Title or Position: OWNER
Credential: PHARMD
Phone: 308-284-2242