Healthcare Provider Details

I. General information

NPI: 1841898004
Provider Name (Legal Business Name): REBECCA LEE FRUSTAGLIO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 10/10/2020
Certification Date: 10/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WILMAR AVE
GRAND ISLAND NE
68803-3547
US

IV. Provider business mailing address

115 WILMAR AVE
GRAND ISLAND NE
68803-3547
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-0328
  • Fax: 308-381-2685
Mailing address:
  • Phone: 308-381-0328
  • Fax: 308-381-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15324
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: