MEDICARE: JILL N LOOS PHARMD

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	183500000X	Pharmacist	11740	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11740	OTHER	NE	STATE LICENSE NO.

General Provider Information

NPI Number	:	1033290333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL N LOOS PHARMD

Provider Business Mailing Address
First Line	:	1417 EUCLID ST
Second Line	:
City	:	ASHLAND
State	:	NE
Zip	:	68003-1333
Country	:	US
Telephone Number	:	402-944-4138
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 SILVER ST
Second Line	:
City	:	ASHLAND
State	:	NE
Zip	:	68003-1845
Country	:	US
Telephone Number	:	402-944-3303
Fax Number	:	402-944-9413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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Directions to “ JILL N LOOS PHARMD” Practice Location

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