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General NPI Number Information
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NPI Number | 1174520332
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Entity Type | Organization
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Legal Business Name | CROSIER PARK PHARMACY LLC
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Dates
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Enumeration Date | 07/02/2005
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 405 E 14TH ST
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City | HASTINGS
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State | NE
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Zip | 68901-3204
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Country | US
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Telephone | 402-462-4600
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Fax | 402-462-4605
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Provider Business Mailing Address
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Address Line | 405 E 14TH ST
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City | HASTINGS
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State | NE
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Zip | 68901-3204
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Country | US
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Telephone | 402-462-4600
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Fax | 402-462-4605
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT A KIRKEGAARD
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Credential | PHARM.D., BCPP
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Telephone | 402-462-4600
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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 | 190
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License Number State | NE
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