Provider Demographics
NPI:1841585536
Name:FSTH INC
Entity Type:Organization
Organization Name:FSTH INC
Other - Org Name:CORNER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:TANBOUZA-HUSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-946-2205
Mailing Address - Street 1:401 G ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-1755
Mailing Address - Country:US
Mailing Address - Phone:308-946-2205
Mailing Address - Fax:308-946-2207
Practice Address - Street 1:401 G ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-1755
Practice Address - Country:US
Practice Address - Phone:308-946-2205
Practice Address - Fax:308-946-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
NE29053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130596OtherPK
NE10026028900Medicaid