Provider Demographics
NPI:1518484039
Name:TOOLEYS OSCEOLA PHARMACY
Entity Type:Organization
Organization Name:TOOLEYS OSCEOLA PHARMACY
Other - Org Name:LTC TOOLEYS OSCEOLA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:C
Authorized Official - Last Name:TOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:402-564-7205
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:NE
Mailing Address - Zip Code:68651-0426
Mailing Address - Country:US
Mailing Address - Phone:402-747-8994
Mailing Address - Fax:402-747-8909
Practice Address - Street 1:415 HAWKEYE ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:NE
Practice Address - Zip Code:68651-4474
Practice Address - Country:US
Practice Address - Phone:402-747-8994
Practice Address - Fax:402-747-8909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOOLEY DRUG COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-25
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE30313336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026420200Medicaid