Healthcare Provider Details

I. General information

NPI: 1164708038
Provider Name (Legal Business Name): CHRIS F SUNDSBOE RP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 N 132ND ST
OMAHA NE
68164-1849
US

IV. Provider business mailing address

3701 N 132ND ST
OMAHA NE
68164-1849
US

V. Phone/Fax

Practice location:
  • Phone: 402-431-0655
  • Fax: 402-431-0589
Mailing address:
  • Phone: 402-431-0655
  • Fax: 402-431-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9015
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: