Healthcare Provider Details

I. General information

NPI: 1285044032
Provider Name (Legal Business Name): BLPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 MAIN ST
NORTH BEND NE
68649-5003
US

IV. Provider business mailing address

748 MAIN ST
NORTH BEND NE
68649-5003
US

V. Phone/Fax

Practice location:
  • Phone: 402-652-3217
  • Fax: 402-652-8219
Mailing address:
  • Phone: 402-652-3217
  • Fax: 402-652-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3034
License Number StateNE

VIII. Authorized Official

Name: MITCH STAIGER
Title or Position: VICE PRESIDENT/PHARMACIST-IN-CHARGE
Credential: PHARMD
Phone: 402-652-3217