Provider Demographics
NPI:1821103383
Name:YUNGDAHLS APOTHECARY INC
Entity Type:Organization
Organization Name:YUNGDAHLS APOTHECARY INC
Other - Org Name:YUNGDAHLS APOTHECARY INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:YUNGDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:402-764-2827
Mailing Address - Street 1:PO BOX 774
Mailing Address - Street 2:309 COMMERCIAL ST
Mailing Address - City:STROMSBURG
Mailing Address - State:NE
Mailing Address - Zip Code:68666-0774
Mailing Address - Country:US
Mailing Address - Phone:402-764-2827
Mailing Address - Fax:402-764-2887
Practice Address - Street 1:309 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:STROMSBURG
Practice Address - State:NE
Practice Address - Zip Code:68666-4414
Practice Address - Country:US
Practice Address - Phone:402-764-2827
Practice Address - Fax:402-764-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2324333600000X
NE29343336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
1178760001Medicare ID - Type Unspecified