Provider Demographics
NPI:1730326844
Name:SILVER STREET COMPOUNDING PHARMACY, INC.
Entity type:Organization
Organization Name:SILVER STREET COMPOUNDING PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-944-9843
Mailing Address - Street 1:1415 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-1845
Mailing Address - Country:US
Mailing Address - Phone:402-944-9843
Mailing Address - Fax:402-944-9413
Practice Address - Street 1:1415 SILVER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NE
Practice Address - Zip Code:68003-1845
Practice Address - Country:US
Practice Address - Phone:402-944-9843
Practice Address - Fax:402-944-9413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25063336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy