Provider Demographics
NPI:1699872416
Name:OCCUVAX LLC
Entity type:Organization
Organization Name:OCCUVAX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MACFARLANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-677-1507
Mailing Address - Street 1:13308 CHANDLER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-3701
Mailing Address - Country:US
Mailing Address - Phone:402-281-2702
Mailing Address - Fax:402-999-8182
Practice Address - Street 1:13308 CHANDLER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-3701
Practice Address - Country:US
Practice Address - Phone:402-281-2702
Practice Address - Fax:402-999-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099379Medicare ID - Type Unspecified