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General NPI Number Information
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NPI Number | 1487794921
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Entity Type | Organization
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Legal Business Name | DTAG PHARMACIES INC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 2123 CENTRAL AVE
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City | KEARNEY
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State | NE
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Zip | 68847-5303
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Country | US
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Telephone | 308-237-2178
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Fax | 308-237-0287
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Provider Business Mailing Address
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Address Line | PO BOX 1599
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City | KEARNEY
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State | NE
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Zip | 68848-1599
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Country | US
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Telephone | 308-237-2178
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Fax | 308-237-0287
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Authorized Official
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Title or Position | OWNER/PRES/PIC
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Name | AMY BRANDT
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Credential | PHRMD
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Telephone | 308-237-2178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care 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 | 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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2886
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License Number State | NE
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