Provider Demographics
NPI:1528615853
Name:NEBRASKA LTC PHARMACY
Entity type:Organization
Organization Name:NEBRASKA LTC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMERSCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-328-0231
Mailing Address - Street 1:284 N 115TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2521
Mailing Address - Country:US
Mailing Address - Phone:402-328-0231
Mailing Address - Fax:402-328-0234
Practice Address - Street 1:284 N 115TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2521
Practice Address - Country:US
Practice Address - Phone:402-328-0231
Practice Address - Fax:402-328-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026035300Medicaid