Provider Demographics
NPI:1659633907
Name:PHARMACY EXPRESS SERVICES INC
Entity Type:Organization
Organization Name:PHARMACY EXPRESS SERVICES INC
Other - Org Name:PHARMACY EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-968-4574
Mailing Address - Street 1:PO BOX 241148
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-5148
Mailing Address - Country:US
Mailing Address - Phone:402-932-8709
Mailing Address - Fax:402-932-8711
Practice Address - Street 1:349 N 78TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3640
Practice Address - Country:US
Practice Address - Phone:402-932-8709
Practice Address - Fax:402-932-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE29353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135620OtherPK