Healthcare Provider Details

I. General information

NPI: 1003047507
Provider Name (Legal Business Name): PROFESSIONAL VETERINARY PRODUCTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10077 S 134TH ST
OMAHA NE
68138-3710
US

IV. Provider business mailing address

10077 S 134TH ST
OMAHA NE
68138-3710
US

V. Phone/Fax

Practice location:
  • Phone: 402-829-5239
  • Fax: 402-829-5343
Mailing address:
  • Phone: 402-829-5239
  • Fax: 402-829-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number2841
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER O'GRADY
Title or Position: PIC, PHARMACY MANAGER
Credential:
Phone: 402-829-5239