Healthcare Provider Details

I. General information

NPI: 1154315141
Provider Name (Legal Business Name): IRMA GAIL DEYLE RP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 30TH ST SUITE 2807
OMAHA NE
68131-2137
US

IV. Provider business mailing address

6241 S 170TH ST
OMAHA NE
68135-3051
US

V. Phone/Fax

Practice location:
  • Phone: 402-449-4560
  • Fax: 402-449-4531
Mailing address:
  • Phone: 402-894-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8990
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: