Provider Demographics
NPI:1790890739
Name:TIGERS PHARMACY INC
Entity Type:Organization
Organization Name:TIGERS PHARMACY INC
Other - Org Name:BENKELMAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHACK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:308-423-2759
Mailing Address - Street 1:509 CHIEF ST
Mailing Address - Street 2:
Mailing Address - City:BENKELMAN
Mailing Address - State:NE
Mailing Address - Zip Code:69021-3065
Mailing Address - Country:US
Mailing Address - Phone:308-423-2759
Mailing Address - Fax:308-423-2760
Practice Address - Street 1:509 CHIEF ST
Practice Address - Street 2:
Practice Address - City:BENKELMAN
Practice Address - State:NE
Practice Address - Zip Code:69021-3065
Practice Address - Country:US
Practice Address - Phone:308-423-2759
Practice Address - Fax:308-423-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE30593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153111OtherPK
2153111OtherPK
NE7451750001Medicare NSC