Provider Demographics
NPI:1518939735
Name:NATIONAL LTC PHARMACY SERVICES
Entity Type:Organization
Organization Name:NATIONAL LTC PHARMACY SERVICES
Other - Org Name:FIVE STAR QUALITY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-489-8676
Mailing Address - Street 1:6891 A STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-489-8676
Mailing Address - Fax:402-489-4367
Practice Address - Street 1:6891 A STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-489-8676
Practice Address - Fax:402-489-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2628333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025161701Medicaid
NE10025161701Medicaid
NE5346200001Medicare NSC