Provider Demographics
NPI:1083797005
Name:VOGT PHARMACIES INC
Entity Type:Organization
Organization Name:VOGT PHARMACIES INC
Other - Org Name:WAHOO PHARMACY AND GIFTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-509-8777
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:402-443-4168
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:402-443-4168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2535333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2053565OtherPK
NE=========00Medicaid
NE=========00Medicaid