Healthcare Provider Details

I. General information

NPI: 1265863880
Provider Name (Legal Business Name): GAC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2013
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N 90TH ST
OMAHA NE
68114
US

IV. Provider business mailing address

825 N 90TH ST
OMAHA NE
68114-2702
US

V. Phone/Fax

Practice location:
  • Phone: 402-614-6363
  • Fax: 402-505-4397
Mailing address:
  • Phone: 402-614-6363
  • Fax: 402-505-4397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number552
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number552
License Number StateNE

VIII. Authorized Official

Name: CHARLES THURSTON TOMLINSON
Title or Position: OWNER/PIC
Credential: RPH.D
Phone: 402-614-6363