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General NPI Number Information
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NPI Number | 1841798683
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Entity Type | Organization
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Legal Business Name | MEADOWLARK PHARMACY LLC
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 18780 S 68TH ST STE B
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City | HICKMAN
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State | NE
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Zip | 68372-7083
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Country | US
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Telephone | 831-277-1871
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Fax | 402-792-0010
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Provider Business Mailing Address
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Address Line | 6510 BEAVER CREEK LN
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City | LINCOLN
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State | NE
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Zip | 68516-3347
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Country | US
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Telephone | 831-277-1871
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/PIC/AO
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Name | JONATHON LAMARQUE
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Credential |
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Telephone | 831-277-1871
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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 | 711
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License Number State | NE
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