Healthcare Provider Details

I. General information

NPI: 1174643100
Provider Name (Legal Business Name): AUTUMN C WURGLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 OAK VIEW DR
OMAHA NE
68144-5632
US

IV. Provider business mailing address

121 S FALL CREEK RD
PAPILLION NE
68133-3342
US

V. Phone/Fax

Practice location:
  • Phone: 402-697-0928
  • Fax: 402-697-1710
Mailing address:
  • Phone: 402-898-4632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11734
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: