Provider Demographics
NPI:1548281595
Name:BERTS DRUG INC
Entity type:Organization
Organization Name:BERTS DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-462-4466
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-0087
Mailing Address - Country:US
Mailing Address - Phone:402-462-4466
Mailing Address - Fax:402-462-4180
Practice Address - Street 1:1021 W 14TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3046
Practice Address - Country:US
Practice Address - Phone:402-462-4466
Practice Address - Fax:402-462-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NE30263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2053260OtherPK
NE=========00Medicaid
0141560001Medicare NSC
2053260OtherPK