Organization
BLPS LLC
Active
Other names
Medicine Man Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MITCH STAIGER PHARMD (VICE PRESIDENT/PHARMACIST-IN-CHARGE)
(402) 652-3217
Entity
Organization
Contact information
Practice address
748 MAIN ST, NORTH BEND, NE 68649-5003
(402) 652-3217
(402) 652-8219
Mailing address
748 MAIN ST, NORTH BEND, NE 68649-5003
(402) 652-3217
(402) 652-8219
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
3034
NE
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026406100
—
NE
01
—
2146052
PK
—
01
—
3034
STATE PHARMACY LICENSE NUMBER
NE
Enumeration date
05/02/2014
Last updated
12/26/2019
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