Healthcare Provider Details

I. General information

NPI: 1265591150
Provider Name (Legal Business Name): PAULA ANN CARLSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N BROADWELL AVE
GRAND ISLAND NE
68803-2153
US

IV. Provider business mailing address

2201 N BROADWELL AVE
GRAND ISLAND NE
68803-2153
US

V. Phone/Fax

Practice location:
  • Phone: 308-362-3660
  • Fax:
Mailing address:
  • Phone: 308-362-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number19976
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number10392
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12299
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: