Provider Demographics
NPI:1538285101
Name:PROMESA HEALTH, INC.
Entity Type:Organization
Organization Name:PROMESA HEALTH, INC.
Other - Org Name:PROMESA HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP/SEC.
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-234-4420
Mailing Address - Street 1:10815 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2607
Mailing Address - Country:US
Mailing Address - Phone:877-234-4409
Mailing Address - Fax:877-234-4429
Practice Address - Street 1:10815 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2607
Practice Address - Country:US
Practice Address - Phone:877-234-4409
Practice Address - Fax:877-234-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2863336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy