MEDICARE: B & R STORES INC

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	3336C0003X	Community/Retail Pharmacy	1530	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	I20027	OTHER		MEDICARE FLU ROSTER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1603364	OTHER	IA	NCPDP

General Provider Information

NPI Number	:	1164455218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B & R STORES INC

Provider Business Mailing Address
First Line	:	4554 W ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68503-2831
Country	:	US
Telephone Number	:	402-464-6297
Fax Number	:	402-434-5732

Provider Business Practice Location Address
First Line	:	4121 FLEUR DR
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-2323
Country	:	US
Telephone Number	:	515-285-5927
Fax Number	:	515-285-8974

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	ANTHONY SCHMID
Credential	:
Telephone Number	:	402-464-6297

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	02/28/2021

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Directions to “B & R STORES INC ” Practice Location

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