Healthcare Provider Details

I. General information

NPI: 1912949793
Provider Name (Legal Business Name): PATEFIELD ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 2ND ST
LAUREL NE
68745-1989
US

IV. Provider business mailing address

PO BOX 515
LAUREL NE
68745-0515
US

V. Phone/Fax

Practice location:
  • Phone: 402-256-3511
  • Fax: 402-256-9230
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2666
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK PATEFIELD
Title or Position: PRESIDENT
Credential:
Phone: 402-256-3511