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NPI Code Detail

MEDICARE: ERNEST JAMES DODGE JR. PHARM D

MEDICARE: ERNEST JAMES DODGE JR. PHARM D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist9713NE

General Provider Information

NPI Number : 1083999262
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERNEST JAMES DODGE JR. PHARM D
Provider Business Mailing Address
First Line : 1404 SUPERIOR ST
Second Line :
City : LINCOLN
State : NE
Zip : 68521-1945
Country : US
Telephone Number : 402-477-2622
Fax Number : 402-477-3751
Provider Business Practice Location Address
First Line : 1404 SUPERIOR ST
Second Line :
City : LINCOLN
State : NE
Zip : 68521-1945
Country : US
Telephone Number : 402-477-2622
Fax Number : 402-477-3751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2011
Last Update Date : 10/19/2011

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