Provider Demographics
NPI:1245244508
Name:PHARMACY EXPRESS SERVICES INC.
Entity Type:Organization
Organization Name:PHARMACY EXPRESS SERVICES INC.
Other - Org Name:NO FRILLS PHARMACY EXPRESS #6
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-341-5226
Mailing Address - Street 1:PO BOX 241148
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-5148
Mailing Address - Country:US
Mailing Address - Phone:402-341-5226
Mailing Address - Fax:
Practice Address - Street 1:3026 S 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1878
Practice Address - Country:US
Practice Address - Phone:402-341-5226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025152600Medicaid
2816873OtherNCPDP
NE10025152600Medicaid