Provider Demographics
NPI:1063726396
Name:SERVICE DRUG, INC
Entity type:Organization
Organization Name:SERVICE DRUG, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-432-2400
Mailing Address - Street 1:302 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2395
Mailing Address - Country:US
Mailing Address - Phone:308-432-2400
Mailing Address - Fax:308-432-4449
Practice Address - Street 1:104 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3412
Practice Address - Country:US
Practice Address - Phone:308-762-2877
Practice Address - Fax:308-762-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies