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NPI Code Detail

MEDICARE: HEATHER HANCOCK PHARM.D., MBA

MEDICARE: HEATHER HANCOCK PHARM.D., MBA
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
1183500000XPharmacist12917NE

General Provider Information

NPI Number : 1700293669
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER HANCOCK PHARM.D., MBA
Provider Business Mailing Address
First Line : 17370 LAKESIDE HILLS PLZ
Second Line :
City : OMAHA
State : NE
Zip : 68130-2352
Country : US
Telephone Number : 402-333-5351
Fax Number : 402-333-5499
Provider Business Practice Location Address
First Line : 17370 LAKESIDE HILLS PLZ
Second Line :
City : OMAHA
State : NE
Zip : 68130-2352
Country : US
Telephone Number : 402-333-5351
Fax Number : 402-333-5499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2014
Last Update Date : 07/11/2014

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