Organization
BP INC
Active
Other names
MEDICINE MAN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JED LEWIS PHARMD (VICE PRESIDENT/PHARMACIST-IN-CHARGE)
(402) 496-9757
Entity
Organization
Contact information
Practice address
15615 PACIFIC ST STE 8, OMAHA, NE 68118-2118
(402) 496-9757
(402) 496-9788
Mailing address
15615 PACIFIC ST STE 8, OMAHA, NE 68118-2118
(402) 496-9757
(402) 496-9788
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2047
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2047
PHARMACY STATE LICENSE NUMBER
NE
01
—
2055104
PK
—
Enumeration date
01/04/2007
Last updated
12/26/2019
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