Healthcare Provider Details

I. General information

NPI: 1427081306
Provider Name (Legal Business Name): JANELLE LYNNAE WORMUTH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
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

2116 ATLANTA ST
GRAND ISLAND NE
68803-2373
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-3660
  • Fax: 308-385-2737
Mailing address:
  • Phone: 308-381-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11156
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: