Wahoo Man LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

WAHOO MAN LLC

Doing business as

Medicine Man Pharmacy

Practice address

526 N Linden St
Wahoo, NE 68066-1961

Phone

(402) 443-4167

Fax

(402) 496-9788

NPI assigned

Aug 16, 2023

Last updated

Aug 16, 2023By 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

Jed Lewis, PHARMD

Title

Vice President

Phone

(402) 652-3217

Specialties & licenses 1

Addresses

Other names 1

• Medicine Man Pharmacy Doing business as

Tax ID family

Wahoo Man 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.

• Wahoo Man LLC

  dba Medicine Man Pharmacy

  • Community/Retail Pharmacy
  • Wahoo, NE
  • NPI 1063089050
  NPD tax ID

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

{
    "created_epoch": "1692144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692144000000",
    "number": "1932982501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 N LINDEN ST",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "680661961",
            "telephone_number": "402-443-4167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 N LINDEN ST",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "680661961",
            "telephone_number": "402-443-4167",
            "fax_number": "402-496-9788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAHOO MAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-16",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "JED",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "402-652-3217",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Man Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark A Vogt
• VSL Wahoo LLC (South Haven)
• Wahoo Dental Associates, P.C.
• Wahoo Family & Sports Medicine, P.C.
• Wahoo Man LLC (Medicine Man Pharmacy)
• Wahoo Medical P.C.
• Wahoo Public Schools
• Wahoo Spine and Sport Chiropractic, P.C.
• Autumn Waldman, RN
• Western Hearing Solutions

• Long Term Care Pharmacy in Wahoo, NE
• Providers in Wahoo, NE by specialty
• Long Term Care Pharmacy in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; 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.