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General NPI Number Information
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NPI Number | 1790885770
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Entity Type | Organization
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Legal Business Name | REDLERS PROFESSIONAL PHARMACY INC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 1010 W 29TH ST STE 208
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City | S SIOUX CITY
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State | NE
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Zip | 68776
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Country | US
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Telephone | 402-494-5542
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Fax | 402-494-2207
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Provider Business Mailing Address
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Address Line | 1010 W 29TH ST STE 208
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City | S SIOUX CITY
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State | NE
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Zip | 68776
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOWELL REDLER
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Credential | RPH
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Telephone | 402-494-5542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1408
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License Number State | NE
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