Provider Demographics
NPI:1326059833
Name:BERTS DRUG INC
Entity Type:Organization
Organization Name:BERTS DRUG INC
Other - Org Name:BERTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:402-462-4466
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-0087
Mailing Address - Country:US
Mailing Address - Phone:402-462-4343
Mailing Address - Fax:402-462-4395
Practice Address - Street 1:700 W 2ND ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5103
Practice Address - Country:US
Practice Address - Phone:402-462-4343
Practice Address - Fax:402-462-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE30253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2053261OtherPK
2053261OtherPK
0141560002Medicare NSC