Provider Demographics
NPI:1497811830
Name:CHERRY COUNTY DRUG
Entity Type:Organization
Organization Name:CHERRY COUNTY DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:402-376-1961
Mailing Address - Street 1:316 N MAIN
Mailing Address - Street 2:
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201
Mailing Address - Country:US
Mailing Address - Phone:402-376-1961
Mailing Address - Fax:402-376-1961
Practice Address - Street 1:316 N MAIN
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:NE
Practice Address - Zip Code:69201
Practice Address - Country:US
Practice Address - Phone:402-376-1961
Practice Address - Fax:402-376-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1901333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2804690OtherNABP