Healthcare Provider Details

I. General information

NPI: 1174976427
Provider Name (Legal Business Name): JSK DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 N. WASHINGTON STREET
PAPILLION NE
68046
US

IV. Provider business mailing address

527 N. WASHINGTON STREET
PAPILLION NE
68046
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-6511
  • Fax: 866-212-6778
Mailing address:
  • Phone: 402-502-6511
  • Fax: 866-212-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. KHATU ERLBACHER
Title or Position: PIC/OWNER
Credential: PHARM.D.
Phone: 402-200-9834