NPIMap

Organization Active NPI

Crosier Park Pharmacy LLC

  • Pharmacy
  • Hastings, NE
National Provider Identifier
1174520332
Registry record updated Jul 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
190 Issued in NE
Legal business name
CROSIER PARK PHARMACY LLC
Practice address
405 E 14TH St
Hastings, NE 68901-3204
Phone
(402) 462-4600
Fax
(402) 462-4605
NPI assigned
Jul 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2013

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

Authorized official

Name
Dr. Scott A Kirkegaard, PHARM.D., BCPPNPI 1447257605
Title
Owner
Phone
(402) 462-4600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 190 NE Primary

Addresses

Primary practice location

405 E 14TH St
Hastings, NE 68901-3204

Mailing address

405 E 14TH St
Hastings, NE 68901-3204
Phone (402) 462-4600

Other identifiers 2

IdentifierTypeStateIssuer
10025267700MedicaidNE
2817091OtherNENCPDP#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930073432 NE DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 0749481018 Practice locations: Hastings, NE
O20130726000098 NE Part B Supplier - Mass Immunization (Roster Biller Only) 0749481018 Practice locations: Hastings, NE

National Provider Directory

National Provider Directory
Tax ID family
Crosier Park Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1120262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374710400000",
    "number": "1174520332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 E 14TH ST",
            "city": "HASTINGS",
            "state": "NE",
            "postal_code": "689013204",
            "telephone_number": "402-462-4600",
            "fax_number": "402-462-4605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 E 14TH ST",
            "city": "HASTINGS",
            "state": "NE",
            "postal_code": "689013204",
            "telephone_number": "402-462-4600",
            "fax_number": "402-462-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSIER PARK PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-02",
        "last_updated": "2013-07-25",
        "status": "A",
        "authorized_official_last_name": "KIRKEGAARD",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-462-4600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D., BCPP"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NE",
            "license": "190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025267700",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP#",
            "identifier": "2817091",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hastings, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2013; 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.