Provider Demographics
NPI:1598800450
Name:WESTERN DRUG CO. OF CHAPPELL, INC.
Entity Type:Organization
Organization Name:WESTERN DRUG CO. OF CHAPPELL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHMID
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:308-874-2200
Mailing Address - Street 1:650 2ND ST.
Mailing Address - Street 2:P.O. BOX 368
Mailing Address - City:CHAPPELL
Mailing Address - State:NE
Mailing Address - Zip Code:69129
Mailing Address - Country:US
Mailing Address - Phone:308-874-2200
Mailing Address - Fax:308-874-3379
Practice Address - Street 1:650 2ND ST.
Practice Address - Street 2:
Practice Address - City:CHAPPELL
Practice Address - State:NE
Practice Address - Zip Code:69129
Practice Address - Country:US
Practice Address - Phone:308-874-2200
Practice Address - Fax:308-874-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2154183500000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE086323Medicaid
NE0214720001Medicare ID - Type Unspecified