Provider Demographics
NPI:1386704120
Name:THIELE PHARMACY
Entity type:Organization
Organization Name:THIELE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LIERK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1308-762-4033
Mailing Address - Street 1:304 BOX BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3342
Mailing Address - Country:US
Mailing Address - Phone:130-876-2403
Mailing Address - Fax:130-876-2896
Practice Address - Street 1:304 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3342
Practice Address - Country:US
Practice Address - Phone:130-876-2403
Practice Address - Fax:130-876-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2800298Medicare ID - Type Unspecified