Provider Demographics
NPI:1104920339
Name:MCCOOK PHARMACY & MEDICAL SUPPLY
Entity type:Organization
Organization Name:MCCOOK PHARMACY & MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:308-345-2560
Mailing Address - Street 1:205 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001
Mailing Address - Country:US
Mailing Address - Phone:308-345-2560
Mailing Address - Fax:308-345-1947
Practice Address - Street 1:205 NORRIS AVE
Practice Address - Street 2:
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001
Practice Address - Country:US
Practice Address - Phone:308-345-2560
Practice Address - Fax:308-345-1947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid