Provider Demographics
NPI:1578740502
Name:FATHER FLANAGANS BOYS HOME
Entity Type:Organization
Organization Name:FATHER FLANAGANS BOYS HOME
Other - Org Name:BOYS TOWN EMPLOYEE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHCY
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SONGSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:402-498-6355
Mailing Address - Street 1:14080 BOYS TOWN HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-7513
Mailing Address - Country:US
Mailing Address - Phone:402-778-6063
Mailing Address - Fax:402-778-6062
Practice Address - Street 1:14080 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010
Practice Address - Country:US
Practice Address - Phone:402-778-6063
Practice Address - Fax:402-778-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE27953336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055968OtherPK