Healthcare Provider Details

I. General information

NPI: 1417904632
Provider Name (Legal Business Name): BREHM REXALL DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 HOWARD AVE
SAINT PAUL NE
68873-2023
US

IV. Provider business mailing address

608 HOWARD AVE PO BOX 185
SAINT PAUL NE
68873-2023
US

V. Phone/Fax

Practice location:
  • Phone: 308-754-4611
  • Fax: 308-754-5696
Mailing address:
  • Phone: 308-754-4611
  • Fax: 308-754-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1013
License Number StateNE

VIII. Authorized Official

Name: JEFF JOHN PLATEK
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 308-754-4611