Provider Demographics
NPI:1679348593
Name:WARRIOR MAN LLC
Entity type:Organization
Organization Name:WARRIOR MAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-887-5551
Mailing Address - Street 1:15615 PACIFIC ST STE 8
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2118
Mailing Address - Country:US
Mailing Address - Phone:402-496-9757
Mailing Address - Fax:402-496-9788
Practice Address - Street 1:108 W 11TH ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1066
Practice Address - Country:US
Practice Address - Phone:402-887-5551
Practice Address - Fax:402-887-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy