Provider Demographics
NPI:1619022365
Name:ALEX AND YVONNE SCHMUNK INC
Entity Type:Organization
Organization Name:ALEX AND YVONNE SCHMUNK INC
Other - Org Name:SONNYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMUNK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:308-262-0580
Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NE
Mailing Address - Zip Code:69336-1058
Mailing Address - Country:US
Mailing Address - Phone:308-262-0580
Mailing Address - Fax:308-262-1736
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:NE
Practice Address - Zip Code:69336-4051
Practice Address - Country:US
Practice Address - Phone:308-262-0580
Practice Address - Fax:308-262-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
NE20933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055131OtherPK
2055131OtherPK
1219090001Medicare NSC