MEDICARE: PROFESSIONAL VETERINARY PRODUCTS LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336S0011X	Specialty Pharmacy
2	3336M0002X	Mail Order Pharmacy	2841	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2817849	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1003047507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL VETERINARY PRODUCTS LTD

Provider Business Mailing Address
First Line	:	10077 S 134TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68138-3710
Country	:	US
Telephone Number	:	402-829-5239
Fax Number	:	402-829-5343

Provider Business Practice Location Address
First Line	:	10077 S 134TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68138-3710
Country	:	US
Telephone Number	:	402-829-5239
Fax Number	:	402-829-5343

Authorized Official
Title or Position	:	PIC, PHARMACY MANAGER
Name	:	JENNIFER O'GRADY
Credential	:
Telephone Number	:	402-829-5239

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	05/28/2010

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