Provider Demographics
NPI:1518599257
Name:LOUDERBACK DRUG OF MADISON, INC.
Entity type:Organization
Organization Name:LOUDERBACK DRUG OF MADISON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LOUDERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:402-454-2525
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NE
Mailing Address - Zip Code:68748-0389
Mailing Address - Country:US
Mailing Address - Phone:402-454-2525
Mailing Address - Fax:402-454-2945
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NE
Practice Address - Zip Code:68748-6485
Practice Address - Country:US
Practice Address - Phone:402-454-2525
Practice Address - Fax:402-454-2945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUDERBACK DRUG OF MADISON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy