Healthcare Provider Details

I. General information

NPI: 1639102890
Provider Name (Legal Business Name): LOURDES M. HEUERMANN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N BROADWELL AVE
GRAND ISLAND NE
68803-2153
US

IV. Provider business mailing address

2212 STAGECOACH RD
GRAND ISLAND NE
68801-7346
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-3660
  • Fax: 308-385-2737
Mailing address:
  • Phone: 308-382-3660
  • Fax: 308-385-2737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberNE9542
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: