Provider Demographics
NPI:1235570714
Name:MITCHELL DRUG
Entity Type:Organization
Organization Name:MITCHELL DRUG
Other - Org Name:MITCHELL DRUG LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-623-2400
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:NE
Mailing Address - Zip Code:69357-0098
Mailing Address - Country:US
Mailing Address - Phone:308-623-2400
Mailing Address - Fax:308-623-2408
Practice Address - Street 1:1456 CENTER AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:NE
Practice Address - Zip Code:69357-1448
Practice Address - Country:US
Practice Address - Phone:308-623-2400
Practice Address - Fax:308-623-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141199OtherPK