Provider Demographics
NPI:1043225659
Name:KORBEL DRUG INC
Entity Type:Organization
Organization Name:KORBEL DRUG INC
Other - Org Name:KORBEL DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS BURKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:402-729-3104
Mailing Address - Street 1:405 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-2501
Mailing Address - Country:US
Mailing Address - Phone:402-729-3104
Mailing Address - Fax:402-729-3104
Practice Address - Street 1:405 5TH ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:NE
Practice Address - Zip Code:68352-2501
Practice Address - Country:US
Practice Address - Phone:402-729-3104
Practice Address - Fax:402-729-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE22613336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2053204OtherPK
NE=========00Medicaid