Healthcare Provider Details

I. General information

NPI: 1790885770
Provider Name (Legal Business Name): REDLERS PROFESSIONAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W 29TH ST STE 208
S SIOUX CITY NE
68776
US

IV. Provider business mailing address

1010 W 29TH ST STE 208
S SIOUX CITY NE
68776
US

V. Phone/Fax

Practice location:
  • Phone: 402-494-5542
  • Fax: 402-494-2207
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1408
License Number StateNE

VIII. Authorized Official

Name: LOWELL REDLER
Title or Position: PRESIDENT
Credential: RPH
Phone: 402-494-5542