Provider Demographics
NPI:1053403139
Name:NORTH PLATTE PHARMACY INC
Entity type:Organization
Organization Name:NORTH PLATTE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:COVEY
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:402-672-1611
Mailing Address - Street 1:211 W LEOTA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6103
Mailing Address - Country:US
Mailing Address - Phone:308-398-1964
Mailing Address - Fax:308-384-1361
Practice Address - Street 1:211 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6103
Practice Address - Country:US
Practice Address - Phone:308-532-0310
Practice Address - Fax:308-532-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026653400Medicaid
2809690OtherNCPDP
2809690OtherNCPDP