Professional Compounding Center of Southeast Nebraska Inc

Primary specialty

PharmacistTaxonomy code 183500000X

License

2345 Issued in NE

Legal business name

PROFESSIONAL COMPOUNDING CENTER OF SOUTHEAST NEBRASKA INC

Practice address

910 E Court St
Ste B
Beatrice, NE 68310-4085

Phone

(402) 223-4774

Fax

(402) 223-5610

NPI assigned

Aug 9, 2005

Organization subpart

No

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

Authorized official

Name

Mitchell E Deines, RP

Title

President

Phone

(402) 223-4774

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073514477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 E COURT ST",
            "address_2": "STE B",
            "city": "BEATRICE",
            "state": "NE",
            "postal_code": "683104085",
            "telephone_number": "402-223-4774",
            "fax_number": "402-223-5610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 E COURT ST",
            "address_2": "STE B",
            "city": "BEATRICE",
            "state": "NE",
            "postal_code": "683104085",
            "telephone_number": "402-223-4774",
            "fax_number": "402-223-5610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL COMPOUNDING CENTER OF SOUTHEAST NEBRASKA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEINES",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-223-4774",
        "authorized_official_credential": "RP"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "NE",
            "license": "2345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47074248301",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "36931",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica L Post
• Katelyn Anne Pretzer
• Hannah Priefert
• Jacqueline Dee Probst, COTA/L
• Nancy Jane Probst, LADC
• Ashley Nicole Putnam
• Micheal Putnam
• Miguel Angel Quintana
• Kailyn R Ramirez
• Trinity Rawson

• Pharmacist in Beatrice, NE
• Providers in Beatrice, NE by specialty
• Pharmacist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.