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General NPI Number Information
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NPI Number | 1982688537
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Entity Type | Organization
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Legal Business Name | BRYAN PLAZA PHARMACY
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1500 S 48TH ST
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City | LINCOLN
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State | NE
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Zip | 68506-1225
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Country | US
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Telephone | 402-481-8383
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Fax | 402-481-3834
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Provider Business Mailing Address
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Address Line | 1500 S 48TH ST
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City | LINCOLN
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State | NE
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Zip | 68506-1225
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Country | US
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Telephone | 402-481-8383
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Fax | 402-481-3834
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. CRAIG DEAN MOORE
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Credential | RPH
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Telephone | 402-481-3034
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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 | 2217
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License Number State | NE
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