Provider Demographics
NPI:1710332101
Name:B & R STORES INC
Entity Type:Organization
Organization Name:B & R STORES INC
Other - Org Name:SUPER SAVER PHARMACY #28
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMID
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:402-464-6297
Mailing Address - Street 1:4554 W ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-2831
Mailing Address - Country:US
Mailing Address - Phone:402-464-6297
Mailing Address - Fax:402-434-5732
Practice Address - Street 1:710 WEST STATE ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801
Practice Address - Country:US
Practice Address - Phone:308-398-0940
Practice Address - Fax:308-398-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NE6683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159911OtherPK