Organization
SERVICE DRUG, INC
Active
Other names
Petersen Drug
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY A PETERSEN RP (PHARMACIST/OWNER)
(308) 432-2400
Entity
Organization
Contact information
Practice address
302 MAIN ST, CHADRON, NE 69337
(308) 432-2400
(308) 432-6759
Mailing address
302 MAIN ST, CHADRON, NE 69337-2395
(308) 432-2400
(308) 432-6759
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
3336C0003X
Community/Retail Pharmacy
1310
NE
3336L0003X
Long Term Care Pharmacy
1310
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36853
BC/BS OF NE
NE
Enumeration date
12/13/2005
Last updated
01/03/2024
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