Organization
PATEFIELD ENTERPRISES INC
Active
Other names
MAIN ST APOTHECARY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PATEFIELD (PRESIDENT)
(402) 256-3511
Entity
Organization
Contact information
Practice address
201 E 2ND ST, LAUREL, NE 68745-1989
(402) 256-3511
(402) 256-9230
Mailing address
PO BOX 515, LAUREL, NE 68745-0515
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2666
NE
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025317900
—
NE
01
—
2810845
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/13/2006
Last updated
01/05/2010
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