Organization
FSTH INC
Active
Other names
corner drug
Organization subpart
No
Provider details
NPI number
Authorized official
FADI TANBOUZA-HUSSEINI (PRESIDENT/PHARMACIST)
(308) 946-2205
Entity
Organization
Contact information
Practice address
401 G ST, CENTRAL CITY, NE 68826-1755
(308) 946-2205
(308) 946-2207
Mailing address
401 G ST, CENTRAL CITY, NE 68826-1755
(308) 946-2205
(308) 946-2207
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2905
NE
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026028900
—
NE
01
—
2130596
PK
—
Enumeration date
06/10/2011
Last updated
03/29/2016
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