Provider Demographics
NPI:1841205291
Name:TRIJON, P.C.
Entity Type:Organization
Organization Name:TRIJON, P.C.
Other - Org Name:VARNEY HEALTH MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TRYTHALL
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:308-872-2321
Mailing Address - Street 1:744 S E ST
Mailing Address - Street 2:P.O. BOX 70
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2428
Mailing Address - Country:US
Mailing Address - Phone:308-872-2321
Mailing Address - Fax:308-872-5753
Practice Address - Street 1:744 S E ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2428
Practice Address - Country:US
Practice Address - Phone:308-872-2321
Practice Address - Fax:308-872-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100252536-00Medicaid
NE5463690001Medicare ID - Type Unspecified