MEDICARE: ALEGENT CREIGHTON HEALTH

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
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1124726179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEGENT CREIGHTON HEALTH

Provider Business Mailing Address
First Line	:	12809 WEST DODGE ROAD
Second Line	:	2ND FLOOR, PHARMACY
City	:	OMAHA
State	:	NE
Zip	:	68154
Country	:	US
Telephone Number	:	402-717-2320
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 N 205TH ST
Second Line	:	SUITE 101
City	:	OMAHA
State	:	NE
Zip	:	68022
Country	:	US
Telephone Number	:	402-758-5560
Fax Number	:	402-758-5565

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	ANN B. THOMPSON
Credential	:
Telephone Number	:	402-717-2320

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	02/21/2023

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Directions to “ALEGENT CREIGHTON HEALTH ” Practice Location

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