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General NPI Number Information
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NPI Number | 1841585536
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Entity Type | Organization
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Legal Business Name | FSTH INC
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 401 G ST
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City | CENTRAL CITY
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State | NE
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Zip | 68826-1755
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Country | US
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Telephone | 308-946-2205
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Fax | 308-946-2207
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Provider Business Mailing Address
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Address Line | 401 G ST
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City | CENTRAL CITY
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State | NE
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Zip | 68826-1755
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Country | US
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Telephone | 308-946-2205
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Fax | 308-946-2207
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST
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Name | FADI TANBOUZA-HUSSEINI
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Credential |
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Telephone | 308-946-2205
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2905
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License Number State | NE
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