Healthcare Provider Details

I. General information

NPI: 1205506250
Provider Name (Legal Business Name): USPRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
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:
Mailing address:
  • Phone: 308-284-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN SCOTT WILSON
Title or Position: OWNER
Credential:
Phone: 308-284-2242