Provider Demographics
NPI:1609141183
Name:LOUDERBACK DRUG OF MADISON, INC.
Entity Type:Organization
Organization Name:LOUDERBACK DRUG OF MADISON, INC.
Other - Org Name:CREUTZ DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUDERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:402-960-1940
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:WAUSA
Mailing Address - State:NE
Mailing Address - Zip Code:68786-0160
Mailing Address - Country:US
Mailing Address - Phone:402-586-2552
Mailing Address - Fax:402-586-2341
Practice Address - Street 1:517 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WAUSA
Practice Address - State:NE
Practice Address - Zip Code:68786-1559
Practice Address - Country:US
Practice Address - Phone:402-586-2552
Practice Address - Fax:402-586-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE28383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2801389OtherNABP
NE2801389OtherNABP