Provider Demographics
NPI:1487654828
Name:DEINES PHARMACY, LLC
Entity Type:Organization
Organization Name:DEINES PHARMACY, LLC
Other - Org Name:DEINES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP MEDICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-301-1307
Mailing Address - Street 1:4924 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3219
Mailing Address - Country:US
Mailing Address - Phone:402-315-1945
Mailing Address - Fax:
Practice Address - Street 1:910 COURT ST STE C
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-4085
Practice Address - Country:US
Practice Address - Phone:402-223-4779
Practice Address - Fax:402-223-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026077200Medicaid
2813928OtherNCPDP
36879OtherBLUE CROSS
NE0459360001Medicare NSC