Healthcare Provider Details

I. General information

NPI: 1285710913
Provider Name (Legal Business Name): SCOTT A. TAYLOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 STATE STREET
OSMOND NE
68765-0036
US

IV. Provider business mailing address

322 STATE STREET
OSMOND NE
68765-0036
US

V. Phone/Fax

Practice location:
  • Phone: 402-749-3708
  • Fax: 402-748-3812
Mailing address:
  • Phone: 402-749-3708
  • Fax: 402-748-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SCOTT A TAYLOR
Title or Position: OWNER CHIEF PHARMACIST
Credential: RP
Phone: 402-748-3708