Provider Demographics
NPI:1073001244
Name:ALLIANCE COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:ALLIANCE COMMUNITY PHARMACY
Other - Org Name:ALLIANCE COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTSCHWAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-629-1045
Mailing Address - Street 1:315 BOX BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3341
Mailing Address - Country:US
Mailing Address - Phone:308-629-1045
Mailing Address - Fax:308-629-1048
Practice Address - Street 1:315 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3341
Practice Address - Country:US
Practice Address - Phone:308-629-1045
Practice Address - Fax:308-629-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE7163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177218OtherPK
NE10026727800Medicaid