Organization
SKAGWAY DISC DEPT. STORES, INC.
Active
Other names
Skagway Pharmacy # 1
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM W BOLTON (SECRETARY)
(308) 384-8222
Entity
Organization
Contact information
Practice address
620 STATE ST, GRAND ISLAND, NE 68801-3552
(308) 384-8228
(308) 384-6835
Mailing address
PO BOX 1647, GRAND ISLAND, NE 68802-1647
(308) 384-8228
(308) 384-6835
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
931
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2800779
NCPDP OR NABP NO.
NE
Enumeration date
02/13/2007
Last updated
08/22/2020
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