Provider Demographics
NPI:1699191734
Name:ARBORPHARM, LLC
Entity Type:Organization
Organization Name:ARBORPHARM, LLC
Other - Org Name:ARBOR STATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WALTKE
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:402-871-7076
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:WYMORE
Mailing Address - State:NE
Mailing Address - Zip Code:68466-0023
Mailing Address - Country:US
Mailing Address - Phone:402-645-3080
Mailing Address - Fax:402-645-3081
Practice Address - Street 1:203 S 7TH ST
Practice Address - Street 2:STE B
Practice Address - City:WYMORE
Practice Address - State:NE
Practice Address - Zip Code:68466
Practice Address - Country:US
Practice Address - Phone:402-645-3080
Practice Address - Fax:402-645-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy