Provider Demographics
NPI:1417048083
Name:USPRX INC
Entity Type:Organization
Organization Name:USPRX INC
Other - Org Name:U SAVE PHARMACY OGALLALA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:THIESZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-398-1964
Mailing Address - Street 1:23 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-2548
Mailing Address - Country:US
Mailing Address - Phone:308-284-2242
Mailing Address - Fax:308-284-8964
Practice Address - Street 1:23 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-2548
Practice Address - Country:US
Practice Address - Phone:308-284-2242
Practice Address - Fax:308-284-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2973333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100262933-00Medicaid
2140301OtherPK
NE100262933-00Medicaid