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General NPI Number Information
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NPI Number | 1538348842
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Entity Type | Organization
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Legal Business Name | EXTENDCARE THE PHARMACY INC
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 1219 N COTNER BLVD
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City | LINCOLN
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State | NE
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Zip | 68505-1837
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Country | US
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Telephone | 402-466-6083
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Fax | 402-466-6086
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Provider Business Mailing Address
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Address Line | 1219 N COTNER BLVD
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City | LINCOLN
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State | NE
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Zip | 68505-1837
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Country | US
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Telephone | 402-466-6083
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Fax | 402-466-6086
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVAN OSENBAUGH
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Credential |
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Telephone | 402-466-7283
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 2978
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License Number State | NE
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