Provider Demographics
NPI:1851448898
Name:BP INC
Entity Type:Organization
Organization Name:BP INC
Other - Org Name:MEDICINE MAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-496-9757
Mailing Address - Street 1:15615 PACIFIC ST STE 8
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2118
Mailing Address - Country:US
Mailing Address - Phone:402-496-9757
Mailing Address - Fax:402-496-9788
Practice Address - Street 1:15615 PACIFIC ST STE 8
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2118
Practice Address - Country:US
Practice Address - Phone:402-496-9757
Practice Address - Fax:402-496-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE20473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055104OtherPK
NE2047OtherPHARMACY STATE LICENSE NUMBER