Provider Demographics
NPI:1629098835
Name:NAGENGAST PHARMACIES INC
Entity Type:Organization
Organization Name:NAGENGAST PHARMACIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPHT, AO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBENHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-373-4411
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68718-0009
Mailing Address - Country:US
Mailing Address - Phone:402-373-4411
Mailing Address - Fax:402-373-4719
Practice Address - Street 1:105 S BROADWAY ST STE 1
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NE
Practice Address - Zip Code:68718-4419
Practice Address - Country:US
Practice Address - Phone:402-373-4411
Practice Address - Fax:402-373-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE28653336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055427OtherPK
NE=========03Medicaid
1319380001Medicare NSC