Healthcare Provider Details

I. General information

NPI: 1699191734
Provider Name (Legal Business Name): ARBORPHARM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S 7TH ST STE B
WYMORE NE
68466
US

IV. Provider business mailing address

PO BOX 23
WYMORE NE
68466-0023
US

V. Phone/Fax

Practice location:
  • Phone: 402-645-3080
  • Fax: 402-645-3081
Mailing address:
  • Phone: 402-645-3080
  • Fax: 402-645-3081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number560
License Number StateNE

VIII. Authorized Official

Name: DR. JEREMY LEE WALTKE
Title or Position: MANAGING MEMBER
Credential: RP
Phone: 402-871-7076