Provider Demographics
NPI:1609224146
Name:MIDLAND VET SERVICES LLC
Entity Type:Organization
Organization Name:MIDLAND VET SERVICES LLC
Other - Org Name:MIDLAND VET SERVICES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-650-0185
Mailing Address - Street 1:11722 STONEGATE CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3692
Mailing Address - Country:US
Mailing Address - Phone:402-330-9483
Mailing Address - Fax:866-420-1589
Practice Address - Street 1:11722 STONEGATE CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3692
Practice Address - Country:US
Practice Address - Phone:402-330-9483
Practice Address - Fax:866-420-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2980333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160325OtherPK