Healthcare Provider Details

I. General information

NPI: 1508321027
Provider Name (Legal Business Name): SPAMM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W 16TH ST
SCHUYLER NE
68661-1668
US

IV. Provider business mailing address

PO BOX 437
NORTH BEND NE
68649-0437
US

V. Phone/Fax

Practice location:
  • Phone: 402-352-3020
  • Fax:
Mailing address:
  • Phone: 402-652-3217
  • Fax: 402-652-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JED LEWIS
Title or Position: VICE PRESIDENT - SECRETARY
Credential:
Phone: 402-652-3217