MEDICARE: SILVER STREET COMPOUNDING PHARMACY, 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	3336C0004X	Compounding Pharmacy	2506	NE

General Provider Information

NPI Number	:	1730326844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER STREET COMPOUNDING PHARMACY, INC.

Provider Business Mailing Address
First Line	:	1415 SILVER ST
Second Line	:
City	:	ASHLAND
State	:	NE
Zip	:	68003-1845
Country	:	US
Telephone Number	:	402-944-9843
Fax Number	:	402-944-9413

Provider Business Practice Location Address
First Line	:	1415 SILVER ST
Second Line	:
City	:	ASHLAND
State	:	NE
Zip	:	68003-1845
Country	:	US
Telephone Number	:	402-944-9843
Fax Number	:	402-944-9413

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. STACI LEE HUBERT
Credential	:	PHARM.D.
Telephone Number	:	402-944-9843

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	01/12/2009

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