Provider Demographics
NPI:1932982501
Name:WAHOO MAN LLC
Entity type:Organization
Organization Name:WAHOO MAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-652-3217
Mailing Address - Street 1:526 N LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-1961
Mailing Address - Country:US
Mailing Address - Phone:402-443-4167
Mailing Address - Fax:
Practice Address - Street 1:526 N LINDEN ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-1961
Practice Address - Country:US
Practice Address - Phone:402-443-4167
Practice Address - Fax:402-496-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy