Provider Demographics
NPI:1770932436
Name:DONIPHAN PHARMACY LLC
Entity type:Organization
Organization Name:DONIPHAN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST-IN-CGARGE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KIRKEGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-462-4600
Mailing Address - Street 1:2011 W CLARICE ST
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:NE
Mailing Address - Zip Code:68832-8701
Mailing Address - Country:US
Mailing Address - Phone:402-462-4600
Mailing Address - Fax:
Practice Address - Street 1:2011 WEST CLARICE
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:NE
Practice Address - Zip Code:68832
Practice Address - Country:US
Practice Address - Phone:402-462-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy