Provider Demographics
NPI:1598834442
Name:MCKINNEYS FOOD CENTER LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:MCKINNEYS FOOD CENTER LIMITED LIABILITY COMPANY
Other - Org Name:MCKINNEYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-332-5167
Mailing Address - Street 1:215 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7883
Mailing Address - Country:US
Mailing Address - Phone:402-332-5167
Mailing Address - Fax:402-332-5184
Practice Address - Street 1:215 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7883
Practice Address - Country:US
Practice Address - Phone:402-332-5167
Practice Address - Fax:402-332-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE22983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47054216600Medicaid
2814932OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2814932OtherNCPDP PROVIDER IDENTIFICATION NUMBER