Service Drug, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SERVICE DRUG, INC

Doing business as

Petersen Drug

Practice address

302 Main St
Chadron, NE 69337

Phone

(308) 432-2400

Fax

(308) 432-6759

NPI assigned

Dec 13, 2005

Last updated

Jan 3, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gary A Petersen, RP

Title

Pharmacist/Owner

Phone

(308) 432-2400

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Petersen Drug Doing business as

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Service Drug, Inc

  dba Petersen Drug

  • Durable Medical Equipment & Medical Supplies
  • Alliance, NE
  • NPI 1063726396

  1456493766

  Same PAC ID
• Service Drug, Inc

  dba Petersen Drug

  • Durable Medical Equipment & Medical Supplies
  • Scottsbluff, NE
  • NPI 1861706715

  1456493766

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1154306165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 MAIN ST",
            "city": "CHADRON",
            "state": "NE",
            "postal_code": "693372395",
            "telephone_number": "308-432-2400",
            "fax_number": "308-432-6759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 MAIN ST",
            "city": "CHADRON",
            "state": "NE",
            "postal_code": "69337",
            "telephone_number": "308-432-2400",
            "fax_number": "308-432-6759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERVICE DRUG, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-13",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "308-432-2400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RP"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NE",
            "license": "1310",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NE",
            "license": "1310",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF NE",
            "identifier": "36853",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petersen Drug",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Petersen Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Chadron, NE
• Providers in Chadron, NE by specialty
• Durable Medical Equipment & Medical Supplies in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.