Wahoo Man LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

WAHOO MAN LLC

Practice address

526 N Linden St
Wahoo, NE 68066-1961

Phone

(402) 443-4167

NPI assigned

Jun 8, 2021

Organization subpart

Yes

Parent organization

BP INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jed Lewis, PHARMD

Title

Vice President

Phone

(402) 652-3217

Specialties & licenses 3

Addresses

Other names 1

• Medicine Man Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NE2 enrollments

Enrollment records 2

Tax ID family

Wahoo Man LLC2 organizations share this tax ID, including this one

Part of

BP Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wahoo Man LLC

  • Long Term Care Pharmacy
  • Wahoo, NE
  • NPI 1932982501
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623110400000",
    "number": "1063089050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 437",
            "city": "NORTH BEND",
            "state": "NE",
            "postal_code": "686490437",
            "telephone_number": "402-652-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 N LINDEN ST",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "680661961",
            "telephone_number": "402-443-4167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAHOO MAN LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BP INC",
        "enumeration_date": "2021-06-08",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "JED",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "402-652-3217",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Man Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vogt Pharmacies Inc
• Mark A Vogt
• VSL Wahoo LLC
• Wahoo Dental Associates, P.C.
• Wahoo Family & Sports Medicine, P.C.
• Wahoo Man LLC
• Wahoo Medical P.C.
• Wahoo Public Schools
• Wahoo Spine and Sport Chiropractic, P.C.
• Autumn Waldman, RN

• Community/Retail Pharmacy in Wahoo, NE
• Providers in Wahoo, NE by specialty
• Community/Retail Pharmacy in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.