Healthcare Provider Details

I. General information

NPI: 1568095115
Provider Name (Legal Business Name): SYRACUSE TOWN & COUNTRY PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 POPLAR
SYRACUSE NE
68446-6844
US

IV. Provider business mailing address

PO BOX 220
SYRACUSE NE
68446-0220
US

V. Phone/Fax

Practice location:
  • Phone: 402-269-2001
  • Fax: 402-269-2828
Mailing address:
  • Phone: 402-269-2001
  • Fax: 402-269-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RONDA RENEE STINSON
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 402-269-3847