Provider Demographics
NPI:1194108688
Name:NEIGHBORHOOD LTC PHARMACY INC.
Entity type:Organization
Organization Name:NEIGHBORHOOD LTC PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUDERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-802-4871
Mailing Address - Street 1:1265 S COTNER BLVD STE 30
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4924
Mailing Address - Country:US
Mailing Address - Phone:402-488-1184
Mailing Address - Fax:402-488-1187
Practice Address - Street 1:5115 S 111TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2341
Practice Address - Country:US
Practice Address - Phone:402-983-9600
Practice Address - Fax:402-983-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3063332B00000X
333600000X, 3336S0011X
IA45873336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026514000Medicaid
2152887OtherPK