Provider Demographics
NPI:1184650814
Name:B & R STORES INC
Entity Type:Organization
Organization Name:B & R STORES INC
Other - Org Name:HAEBERLE'S GRAND CENTRAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-464-6297
Mailing Address - Street 1:7 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-4432
Mailing Address - Country:US
Mailing Address - Phone:308-237-2545
Mailing Address - Fax:308-234-3093
Practice Address - Street 1:7 W 25TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4432
Practice Address - Country:US
Practice Address - Phone:308-237-2545
Practice Address - Fax:308-234-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47072894000Medicaid
2120861OtherPK
2120861OtherPK