Healthcare Provider Details

I. General information

NPI: 1538348842
Provider Name (Legal Business Name): EXTENDCARE THE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 N COTNER BLVD
LINCOLN NE
68505-1837
US

IV. Provider business mailing address

1219 N COTNER BLVD
LINCOLN NE
68505-1837
US

V. Phone/Fax

Practice location:
  • Phone: 402-466-6083
  • Fax: 402-466-6086
Mailing address:
  • Phone: 402-466-6083
  • Fax: 402-466-6086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2978
License Number StateNE

VIII. Authorized Official

Name: STEVAN OSENBAUGH
Title or Position: PRESIDENT
Credential:
Phone: 402-466-7283