Provider Demographics
NPI:1750306619
Name:TOWN AND COUNTRY PHARMACY INC
Entity Type:Organization
Organization Name:TOWN AND COUNTRY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:NUNNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-759-4433
Mailing Address - Street 1:1014 G ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361-2007
Mailing Address - Country:US
Mailing Address - Phone:402-759-4433
Mailing Address - Fax:402-759-4417
Practice Address - Street 1:1014 G ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361-2007
Practice Address - Country:US
Practice Address - Phone:402-759-4433
Practice Address - Fax:402-759-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1574332B00000X, 332BN1400X, 333600000X, 3336C0003X, 3336C0003X, 3336S0011X, 3336H0001X, 3336L0003X, 3336M0002X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4706198800Medicaid
NE09020OtherBCBS PAR
NE099443Medicare ID - Type UnspecifiedPART B
0254050001Medicare NSC