Healthcare Provider Details

I. General information

NPI: 1053854018
Provider Name (Legal Business Name): SPRINGFIELDDRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MAIN ST
SPRINGFIELD NE
68059-3230
US

IV. Provider business mailing address

PO BOX 130
SPRINGFIELD NE
68059-0130
US

V. Phone/Fax

Practice location:
  • Phone: 402-253-2000
  • Fax: 402-253-2001
Mailing address:
  • Phone: 402-253-2000
  • Fax: 402-253-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8552
License Number StateNE

VIII. Authorized Official

Name: MR. KEITH RONALD HENTZEN
Title or Position: OWNER
Credential: RP
Phone: 402-253-2000