Provider Demographics
NPI:1992836357
Name:REIMER PHARMACY LLC
Entity Type:Organization
Organization Name:REIMER PHARMACY LLC
Other - Org Name:REIMER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-536-2641
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:NE
Mailing Address - Zip Code:68638-0460
Mailing Address - Country:US
Mailing Address - Phone:308-536-2641
Mailing Address - Fax:308-536-2680
Practice Address - Street 1:312 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:NE
Practice Address - Zip Code:68638-3152
Practice Address - Country:US
Practice Address - Phone:308-536-2641
Practice Address - Fax:308-536-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
NE30413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149429OtherPK
NE100264488-00Medicaid