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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	709	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2172487	OTHER		PK

General Provider Information

NPI Number	:	1487165452
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	:	5460 S 56TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-1879
Country	:	US
Telephone Number	:	402-423-0870
Fax Number	:	402-423-0873

Authorized Official
Title or Position	:	PHARMACY DIRECTOR/AO/PIC
Name	:	ANTHONY SCHMID
Credential	:	RPH
Telephone Number	:	402-464-6297

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	01/31/2018

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