Organization Active NPI

Skagway Disc Dept. Stores, Inc.

  • Community/Retail Pharmacy
  • Grand Island, NE
National Provider Identifier
1720120025
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
931 Issued in NE
Legal business name
SKAGWAY DISC DEPT. STORES, INC.
Doing business as
Skagway Pharmacy # 1
Practice address
620 State St
Grand Island, NE 68801-3552
Phone
(308) 384-8228
Fax
(308) 384-6835
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Tim W Bolton
Title
Secretary
Phone
(308) 384-8222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 931 NE Primary

Addresses

Primary practice location

620 State St
Grand Island, NE 68801-3552

Mailing address

PO Box 1647
Grand Island, NE 68802-1647
Phone (308) 384-8228

Other identifiers 1

IdentifierTypeStateIssuer
2800779OtherNENCPDP OR NABP NO.

Other names 1

  • Skagway Pharmacy # 1 Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720120025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1647",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688021647",
            "telephone_number": "308-384-8228",
            "fax_number": "308-384-6835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 STATE ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688013552",
            "telephone_number": "308-384-8228",
            "fax_number": "308-384-6835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKAGWAY DISC DEPT. STORES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "TIM",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "308-384-8222",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NE",
            "license": "931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP OR NABP NO.",
            "identifier": "2800779",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skagway Pharmacy # 1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Island, NE

Sources for this page

  • 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.