Provider Demographics
NPI:1376552851
Name:FRIENDLY NEIGHBOR HEALTHCARE, LLC
Entity Type:Organization
Organization Name:FRIENDLY NEIGHBOR HEALTHCARE, LLC
Other - Org Name:ELGIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARRAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-843-5555
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:NE
Mailing Address - Zip Code:68636-0429
Mailing Address - Country:US
Mailing Address - Phone:402-843-5555
Mailing Address - Fax:402-843-5551
Practice Address - Street 1:112 S 2ND ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:NE
Practice Address - Zip Code:68636-4409
Practice Address - Country:US
Practice Address - Phone:402-843-5555
Practice Address - Fax:402-843-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336M0002X
NE27513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026660802Medicaid
NE10025557800Medicaid
2814261OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5999460001Medicare NSC