MEDICARE: FOUR STAR DRUG OF BETHANY 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	1290	NE

General Provider Information

NPI Number	:	1194898197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR STAR DRUG OF BETHANY INC

Provider Business Mailing Address
First Line	:	1340 N 66TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-1822
Country	:	US
Telephone Number	:	402-434-7701
Fax Number	:	402-434-7744

Provider Business Practice Location Address
First Line	:	1340 N 66TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-1822
Country	:	US
Telephone Number	:	402-434-7701
Fax Number	:	402-434-7744

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY OPERATIONS
Name	:	DR. MONTY LEE SCHEELE
Credential	:	PHARM.D.
Telephone Number	:	402-434-7701

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	02/11/2014

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