South Loup Community Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2897 Issued in NE

Legal business name

SOUTH LOUP COMMUNITY PHARMACY

Doing business as

South Loup Community Pharmacy

Practice address

200 E Pacific St
Callaway, NE 68825-2500

Phone

(308) 836-2219

Fax

(308) 836-2625

NPI assigned

Nov 16, 2010

Last updated

Dec 30, 2022By 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

Brett D Eggleston

Title

Ceo

Phone

(308) 836-2228

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Loup Community Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NE2 enrollments

Enrollment records 2

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

Locations

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

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672358400000",
    "number": "1902107345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E PACIFIC ST",
            "address_2": "P.O. BOX 220",
            "city": "CALLAWAY",
            "state": "NE",
            "postal_code": "688252500",
            "telephone_number": "308-836-2219",
            "fax_number": "308-836-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E PACIFIC ST",
            "city": "CALLAWAY",
            "state": "NE",
            "postal_code": "688252500",
            "telephone_number": "308-836-2219",
            "fax_number": "308-836-2625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LOUP COMMUNITY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-16",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A",
        "authorized_official_last_name": "EGGLESTON",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "308-836-2228"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NE",
            "license": "2897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2127586",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Loup Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bethany Jean Rheiner, PA-C
• Kristen Ann Rickertsen, APRN
• Timothy Aaron Rosfeld, PA-C
• Stanley Edward Schied, PA-C
• Ronald John Sheppard, MD
• Tiffany L Svoboda, D.O.
• Team Physical Therapy, P.C.
• The Evangelical Lutheran Good Samaritan Society (Good Samaritan Society - Callaway)
• Chelsea M. Williams, M.D.

• Community/Retail Pharmacy in Callaway, NE
• Providers in Callaway, 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 Dec 30, 2022; 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.