Healthcare Provider Details

I. General information

NPI: 1568521466
Provider Name (Legal Business Name): FREMONT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 EAST 23RD STREET
FREMONT NE
68025-2303
US

IV. Provider business mailing address

450 EAST 23RD STREET
FREMONT NE
68025-2303
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-3820
  • Fax: 402-727-3517
Mailing address:
  • Phone: 402-721-1610
  • Fax: 402-727-3433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2361
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2361
License Number StateNE

VIII. Authorized Official

Name: MR. PATRICK M BOOTH
Title or Position: PRESIDENT/CEO
Credential:
Phone: 402-721-1610