# PROVIDENCE MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Community Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700626645
- **Authorized official:** KIMBERLY LUEDERS (PHARMACY DIRECTOR)
- **Authorized official phone:** (402) 375-7920

## Contact information

- **Practice address:** 803 PROVIDENCE RD STE 101, WAYNE, NE 68787-1590
- **Practice address phone:** (402) 375-8862
- **Practice address fax:** (402) 375-8863
- **Mailing address:** 1200 PROVIDENCE RD, WAYNE, NE 68787-1212
- **Mailing address phone:** (402) 375-7920
- **Mailing address fax:** (402) 375-7605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/29/2024
- **Last updated:** 05/29/2024