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General NPI Number Information
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NPI Number | 1619350048
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Entity Type | Organization
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Legal Business Name | GI VILLAGE PHARMACY
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 4075 TIMBERLINE ST
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City | GRAND ISLAND
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State | NE
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Zip | 68803-6553
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Country | US
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Telephone | 308-385-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 300 S 1ST AVE
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City | HASTINGS
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State | NE
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Zip | 68901-6464
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Country | US
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Telephone | 402-463-2441
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Fax | 402-463-2441
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW SCHLACHTER
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Credential |
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Telephone | 402-463-2441
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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 | 612
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License Number State | NE
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