Healthcare Provider Details

I. General information

NPI: 1497347462
Provider Name (Legal Business Name): ATLAS RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11923 PACIFIC ST STE A
OMAHA NE
68154-3468
US

IV. Provider business mailing address

11923 PACIFIC ST STE A
OMAHA NE
68154-3468
US

V. Phone/Fax

Practice location:
  • Phone: 402-520-6601
  • Fax: 402-520-6622
Mailing address:
  • Phone: 402-520-6601
  • Fax: 402-520-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK A. CHERNEY
Title or Position: PHARMACIST-IN-CHARGE
Credential: RPH
Phone: 708-728-5052