Healthcare Provider Details

I. General information

NPI: 1104920339
Provider Name (Legal Business Name): MCCOOK PHARMACY & MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 NORRIS AVE
MCCOOK NE
69001
US

IV. Provider business mailing address

205 NORRIS AVE
MCCOOK NE
69001
US

V. Phone/Fax

Practice location:
  • Phone: 308-345-2560
  • Fax: 308-345-1947
Mailing address:
  • Phone: 308-345-2560
  • Fax: 308-345-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2485
License Number StateNE

VIII. Authorized Official

Name: ANGELA E LANGAN
Title or Position: PRESIDENT
Credential: RP
Phone: 308-345-2560