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General NPI Number Information
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NPI Number | 1124473418
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Entity Type | Organization
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Legal Business Name | NORTH PLATTE PAVILION PHARMACY INC
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 611 W FRANCIS ST STE 130
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City | NORTH PLATTE
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State | NE
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Zip | 69101-0614
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Country | US
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Telephone | 308-221-6993
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Fax | 308-221-6997
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Provider Business Mailing Address
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Address Line | 611 W FRANCIS ST STE 130
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City | NORTH PLATTE
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State | NE
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Zip | 69101-0614
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Country | US
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Telephone | 308-221-6993
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Fax | 308-221-6997
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Authorized Official
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Title or Position | PHARMACIST,AO
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Name | TRAVIS COVEY
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Credential | RPH
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Telephone | 308-221-6993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3094
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License Number State | NE
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