Provider Demographics
NPI:1811623655
Name:CROSIER PARK PHARMACY LLC
Entity Type:Organization
Organization Name:CROSIER PARK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRKEGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-462-4600
Mailing Address - Street 1:405 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3204
Mailing Address - Country:US
Mailing Address - Phone:402-462-4600
Mailing Address - Fax:402-462-4605
Practice Address - Street 1:405 E 14TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3204
Practice Address - Country:US
Practice Address - Phone:402-462-4600
Practice Address - Fax:402-462-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy