Provider Demographics
NPI:1376659078
Name:B & R STORES, INC
Entity Type:Organization
Organization Name:B & R STORES, INC
Other - Org Name:SUPER SAVER PHARMACY #12
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:SCHMID
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-464-6297
Mailing Address - Street 1:1141 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1513
Mailing Address - Country:US
Mailing Address - Phone:712-322-9019
Mailing Address - Fax:712-325-9731
Practice Address - Street 1:1141 N BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1513
Practice Address - Country:US
Practice Address - Phone:712-322-9019
Practice Address - Fax:712-325-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA9723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0094664Medicaid
IA0755930005Medicare ID - Type Unspecified