Provider Demographics
NPI:1053854018
Name:SPRINGFIELDDRUG
Entity Type:Organization
Organization Name:SPRINGFIELDDRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:HENTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:402-253-2000
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68059-0130
Mailing Address - Country:US
Mailing Address - Phone:402-253-2000
Mailing Address - Fax:402-253-2001
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NE
Practice Address - Zip Code:68059-3230
Practice Address - Country:US
Practice Address - Phone:402-253-2000
Practice Address - Fax:402-253-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE85523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy