Healthcare Provider Details

I. General information

NPI: 1013205251
Provider Name (Legal Business Name): ANDREA WALTER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S 70TH ST
LINCOLN NE
68510-2451
US

IV. Provider business mailing address

4500 NW 54TH ST
LINCOLN NE
68524-1025
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-3802
  • Fax: 402-486-7860
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13656
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: