Healthcare Provider Details

I. General information

NPI: 1417048083
Provider Name (Legal Business Name): USPRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 N SPRUCE ST
OGALLALA NE
69153-2548
US

IV. Provider business mailing address

23 N SPRUCE ST
OGALLALA NE
69153-2548
US

V. Phone/Fax

Practice location:
  • Phone: 308-284-2242
  • Fax: 308-284-8964
Mailing address:
  • Phone: 308-284-2242
  • Fax: 308-284-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2973
License Number StateNE

VIII. Authorized Official

Name: SHELBY THIESZEN
Title or Position: SECRETARY
Credential:
Phone: 308-398-1964