Provider Demographics
NPI:1619350048
Name:GI VILLAGE PHARMACY
Entity Type:Organization
Organization Name:GI VILLAGE PHARMACY
Other - Org Name:GI VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLACHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-463-2441
Mailing Address - Street 1:300 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6464
Mailing Address - Country:US
Mailing Address - Phone:402-463-2441
Mailing Address - Fax:402-463-2441
Practice Address - Street 1:4075 TIMBERLINE ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-6553
Practice Address - Country:US
Practice Address - Phone:308-385-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6123336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152765OtherPK