Provider Demographics
NPI:1568095115
Name:SYRACUSE TOWN & COUNTRY PHARMACY, INC
Entity Type:Organization
Organization Name:SYRACUSE TOWN & COUNTRY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-269-3847
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-0220
Mailing Address - Country:US
Mailing Address - Phone:402-269-2001
Mailing Address - Fax:402-269-2828
Practice Address - Street 1:1710 POPLAR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446-6844
Practice Address - Country:US
Practice Address - Phone:402-269-2001
Practice Address - Fax:402-269-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy