Provider Demographics
NPI:1154426328
Name:INTEGRATED HMO PHARMACY SERVICES
Entity type:Organization
Organization Name:INTEGRATED HMO PHARMACY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF IHMO PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:800-663-7928
Mailing Address - Street 1:13660 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5233
Mailing Address - Country:US
Mailing Address - Phone:800-633-7928
Mailing Address - Fax:800-801-2395
Practice Address - Street 1:13660 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5233
Practice Address - Country:US
Practice Address - Phone:800-633-7928
Practice Address - Fax:800-801-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27733336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy