Provider Demographics
NPI:1598846248
Name:ALEGENT HEALTH MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ALEGENT HEALTH MEMORIAL HOSPITAL
Other - Org Name:ALEGENT HEALTH MEMORIAL HOSPITAL - CLARKSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO - CHI HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4420
Mailing Address - Street 1:329 PINE ST
Mailing Address - Street 2:PO BOX 20
Mailing Address - City:CLARKSON
Mailing Address - State:NE
Mailing Address - Zip Code:68629-4094
Mailing Address - Country:US
Mailing Address - Phone:402-892-3466
Mailing Address - Fax:402-892-3113
Practice Address - Street 1:329 PINE ST
Practice Address - Street 2:
Practice Address - City:CLARKSON
Practice Address - State:NE
Practice Address - Zip Code:68629-4094
Practice Address - Country:US
Practice Address - Phone:402-892-3466
Practice Address - Fax:402-892-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10023833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2813245OtherNCPDP
A03978787OtherDEA
A03978787OtherDEA