Provider Demographics
NPI:1790885770
Name:REDLERS PROFESSIONAL PHARMACY INC
Entity Type:Organization
Organization Name:REDLERS PROFESSIONAL PHARMACY INC
Other - Org Name:REDLERS PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:REDLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:402-494-5542
Mailing Address - Street 1:1010 W 29TH ST
Mailing Address - Street 2:STE 208
Mailing Address - City:S SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 W 29TH ST
Practice Address - Street 2:STE 208
Practice Address - City:S SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776
Practice Address - Country:US
Practice Address - Phone:402-494-5542
Practice Address - Fax:402-494-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2804741OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2804741OtherOTHER ID NUMBER
IA0970814Medicaid
2804741OtherOTHER ID NUMBER
NE=========00Medicaid