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General NPI Number Information
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NPI Number | 1548719271
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Entity Type | Organization
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Legal Business Name | GENEVA PHARMACY LLC
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 20513 NICHOLAS CIR STE 3
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City | ELKHORN
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State | NE
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Zip | 68022-2971
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Country | US
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Telephone | 402-759-9104
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Fax | 402-718-9421
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Provider Business Mailing Address
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Address Line | 20513 NICHOLAS CIR STE 3
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City | ELKHORN
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State | NE
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Zip | 68022-2971
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Country | US
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Telephone | 402-759-9104
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Fax | 402-718-9421
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Authorized Official
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Title or Position | PIC/MANAGING MEMBER
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Name | TANNER CHRISTIAN ANDERSON
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Credential | RPH
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Telephone | 402-281-1956
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 677
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License Number State | NE
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