=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821247552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | U-SAVE PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2008
-----------------------------------------------------
Last Update Date | 05/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 940 N 204TH AVE STE 270
-----------------------------------------------------
City | ELKHORN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68022-4606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-289-2576
-----------------------------------------------------
Fax | 402-289-2540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 968
-----------------------------------------------------
City | ELKHORN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68022-0968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-289-2576
-----------------------------------------------------
Fax | 402-289-2540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | LYNN LONGCOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-289-2576
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 2815
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------